Healthcare Provider Details

I. General information

NPI: 1376216507
Provider Name (Legal Business Name): JOEL ADOQUAYE ALLOTEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2021
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 ATKINSON DR STE 111
LUDINGTON MI
49431-1917
US

IV. Provider business mailing address

100 MICHIGAN ST NE # MC845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 231-843-3487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301512369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: