Healthcare Provider Details

I. General information

NPI: 1861948184
Provider Name (Legal Business Name): EMMANUEL ACHEAMPONG ADOMAKO MB, CHB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

IV. Provider business mailing address

3901 RAINBOW BLVD
KANSAS CITY KS
66160-8500
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6048
  • Fax:
Mailing address:
  • Phone: 913-588-6048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number04-45769
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: