Healthcare Provider Details

I. General information

NPI: 1750678355
Provider Name (Legal Business Name): KYRENE INTERNAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E CHANDLER BLVD SUITE 201
PHOENIX AZ
85048-7643
US

IV. Provider business mailing address

4545 E CHANDLER BLVD SUITE 201
PHOENIX AZ
85048-7643
US

V. Phone/Fax

Practice location:
  • Phone: 480-598-4145
  • Fax: 480-598-4346
Mailing address:
  • Phone: 480-598-4145
  • Fax: 480-598-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. FRANK OPPONG-TAKYI
Title or Position: PHYSICIAN
Credential:
Phone: 480-598-4145