MEDICARE: AKINTUNDE MIKE AKINJERO M.D

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	01100427A	IN
2	207R00000X	Internal Medicine Physician	A171700	CA
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	337074	NY

General Provider Information

NPI Number	:	1982085973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKINTUNDE MIKE AKINJERO M.D

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:	518-525-5634
Fax Number	:	518-649-4094

Provider Business Practice Location Address
First Line	:	5 PALISADES DR STE 100
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12205-6433
Country	:	US
Telephone Number	:	518-438-4496
Fax Number	:	518-438-5803

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/17/2026

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