Healthcare Provider Details

I. General information

NPI: 1720838097
Provider Name (Legal Business Name): PRISCILLA OBENG KWARTENG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 06/15/2024
Certification Date: 06/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1969 W OGDEN AVE FL 4
CHICAGO IL
60612-3765
US

IV. Provider business mailing address

1969 W OGDEN AVE FL 4
CHICAGO IL
60612-3765
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-4166
  • Fax: 312-864-9954
Mailing address:
  • Phone: 312-864-4166
  • Fax: 312-864-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.084550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: