Healthcare Provider Details

I. General information

NPI: 1144519810
Provider Name (Legal Business Name): ADIKUOR OHENEWA ADJETEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 SAINT MARYS RD
JUNCTION CITY KS
66441-4139
US

IV. Provider business mailing address

2821 ELM CREEK DRIVE
JUNCTION CITY KS
66441
US

V. Phone/Fax

Practice location:
  • Phone: 785-238-4131
  • Fax:
Mailing address:
  • Phone: 361-834-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0434941
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: