Healthcare Provider Details

I. General information

NPI: 1790245892
Provider Name (Legal Business Name): AMMA SERWAA OWUSU-AKYAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 03/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 MCAULEY DR RM 2110
YPSILANTI MI
48197-1097
US

IV. Provider business mailing address

180 W MARKET ST APT 638
NEWARK NJ
07103-2787
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3967
  • Fax:
Mailing address:
  • Phone: 732-609-6286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: