Healthcare Provider Details

I. General information

NPI: 1356925440
Provider Name (Legal Business Name): KOFI ANKOMAH NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 W BYRON ST
CHICAGO IL
60641-2712
US

IV. Provider business mailing address

4840 W BYRON ST
CHICAGO IL
60641-2712
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-7800
  • Fax: 773-282-2163
Mailing address:
  • Phone: 224-866-9641
  • Fax: 773-282-2163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021013060
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209023280
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: