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1679567580

NPI Code Detail

MEDICARE: MR. CHARLES N EKINDE MD

MEDICARE: MR. CHARLES N EKINDE 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
1	207R00000X	Internal Medicine Physician	059633	GA
2	208M00000X	Hospitalist Physician	ME87673	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	511I110352	OTHER	GA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679567580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHARLES N EKINDE MD

Provider Business Mailing Address
First Line	:	PO BOX 198054
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8054
Country	:	US
Telephone Number	:	786-467-2159
Fax Number	:

Provider Business Practice Location Address
First Line	:	9555 SW 162ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-6408
Country	:	US
Telephone Number	:	786-467-2159
Fax Number	:	786-533-9703

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

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/20/2022

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Directions to “ MR. CHARLES N EKINDE MD” Practice Location

Language	Start Address	Practice Location

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