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NPI Code Detail

MEDICARE: DR. AVOSUASHI AKANDE MD

MEDICARE: DR. AVOSUASHI AKANDE MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician4301506355MI

General Provider Information

NPI Number : 1669035366
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AVOSUASHI AKANDE MD
Provider Business Mailing Address
First Line : 26901 BEAUMONT BLVD STE 3D
Second Line :
City : SOUTHFIELD
State : MI
Zip : 48033-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14001 GREENFIELD RD
Second Line :
City : DETROIT
State : MI
Zip : 48227-2101
Country : US
Telephone Number : 313-273-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2019
Last Update Date : 08/31/2022

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