MEDICARE: MARY OLUWAKEMI AKANDE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	0019511	WI

General Provider Information

NPI Number	:	1497604805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY OLUWAKEMI AKANDE

Provider Business Mailing Address
First Line	:	504 E RANDY RD
Second Line	:
City	:	OAK CREEK
State	:	WI
Zip	:	53154-7090
Country	:	US
Telephone Number	:	414-588-8355
Fax Number	:

Provider Business Practice Location Address
First Line	:	6011 S ELAINE AVE
Second Line	:
City	:	CUDAHY
State	:	WI
Zip	:	53110-2914
Country	:	US
Telephone Number	:	414-588-8355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/29/2026

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