Healthcare Provider Details

I. General information

NPI: 1922612522
Provider Name (Legal Business Name): DENNIS DANSO KUMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

6800 N SUMMERSHADE CIR APT T
PEORIA IL
61615-8981
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-8818
  • Fax: 309-624-8820
Mailing address:
  • Phone: 312-684-8168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036164086
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125076954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: