Provider Demographics
NPI:1144251679
Name:ADEDOKUN, AKEEB (MD)
Entity type:Individual
Prefix:
First Name:AKEEB
Middle Name:
Last Name:ADEDOKUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 ROMAINE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5058 ROMAINE SPRING DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-5868
Practice Address - Country:US
Practice Address - Phone:636-326-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003024384207QG0300X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208784009Medicaid
196690OtherBLUE CROSS BLUE SHIELD
MO915085198Medicare PIN
196690OtherBLUE CROSS BLUE SHIELD
MO915083212Medicare PIN
MO208784009Medicaid