MEDICARE: DR. KWAKU ANINAGYEI YEBOAH

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	183500000X	Pharmacist	5302043926	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5302043926	OTHER	MI	MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS

General Provider Information

NPI Number	:	1689021495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KWAKU ANINAGYEI YEBOAH

Provider Business Mailing Address
First Line	:	3050 BAY RD
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-2415
Country	:	US
Telephone Number	:	989-792-9606
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 BAY RD
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-2415
Country	:	US
Telephone Number	:	989-792-9606
Fax Number	:

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

Provider Enumeration Date	:	05/21/2016
Last Update Date	:	05/21/2016

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