MEDICARE: COMFORT C. ONYIAH MD MPH

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	2083P0901X	Public Health & General Preventive Medicine Physician	57028	MN
2	207Q00000X	Family Medicine Physician	57028	MN
3	207Q00000X	Family Medicine Physician	D0071839	MD
4	2083P0901X	Public Health & General Preventive Medicine Physician	D0071839	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57028	OTHER	MN	MINNESOTA LICENSE NUMBER
2	D0071839	OTHER	MD	MARYLAND LICENCE NUMBER

General Provider Information

NPI Number	:	1588830756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COMFORT C. ONYIAH MD MPH

Provider Business Mailing Address
First Line	:	1580 WHITE OAK DR
Second Line	:	SUITE 100
City	:	CHASKA
State	:	MN
Zip	:	55318-2919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1580 WHITE OAK DR
Second Line	:	SUITE 100
City	:	CHASKA
State	:	MN
Zip	:	55318-2919
Country	:	US
Telephone Number	:	952-544-8800
Fax Number	:

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	06/02/2014

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