1033492434 NPI number — DR. FEYISARA R AKANKI-AHMAD MD

Table of content: DR. FEYISARA R AKANKI-AHMAD MD (NPI 1033492434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033492434 NPI number — DR. FEYISARA R AKANKI-AHMAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKANKI-AHMAD
Provider First Name:
FEYISARA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AKANKI
Provider Other First Name:
FEYISARA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033492434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3310 LIVE OAK, 3RD FLOOR
Provider Second Line Business Mailing Address:
COPC ADMNISTRATION,
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
25204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-266-1256
Provider Business Mailing Address Fax Number:
214-266-1256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3310 LIVE OAK, 3RD FLOOR
Provider Second Line Business Practice Location Address:
COPC ADMNISTRATION,
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-266-1256
Provider Business Practice Location Address Fax Number:
214-266-1256
Provider Enumeration Date:
09/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  P4018 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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