Provider Demographics
NPI:1053793273
Name:AKINTUNDE, KRISTIE ABIMBOLA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:ABIMBOLA
Last Name:AKINTUNDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KRISTIE
Other - Middle Name:ABIMBOLA
Other - Last Name:ADEBAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2900
Mailing Address - Country:US
Mailing Address - Phone:763-520-2000
Mailing Address - Fax:
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-992-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN63783207R00000X
NY00295603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine