Healthcare Provider Details

I. General information

NPI: 1992143788
Provider Name (Legal Business Name): KELVIN ADJEI-TWUM M.D., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE MC 5068
CHICAGO IL
60637-1447
US

IV. Provider business mailing address

6503 TASSIA DR
ALEXANDRIA VA
22315-6081
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number125-062894
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number102244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: