Healthcare Provider Details

I. General information

NPI: 1538454335
Provider Name (Legal Business Name): RACHEL JEANTY ASUQUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL JEANTY MD

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KADENA AIR BASE
APO AP
96368
US

IV. Provider business mailing address

PSC 80 BOX 22458
APO AP
96367-0109
US

V. Phone/Fax

Practice location:
  • Phone: 312-630-4229
  • Fax:
Mailing address:
  • Phone: 90-978-6237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0078588
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: