Healthcare Provider Details

I. General information

NPI: 1427611748
Provider Name (Legal Business Name): KEITH PETER AMEYAW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 07/03/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16001 W 9 MILE RD OFC
SOUTHFIELD MI
48075-4818
US

IV. Provider business mailing address

550 1ST AVE
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-5664
  • Fax:
Mailing address:
  • Phone: 646-929-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351046727
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number316072-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: