Healthcare Provider Details

I. General information

NPI: 1487888939
Provider Name (Legal Business Name): ANTOINETTE ADOWAA KOTEY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANTOINETTE ADOWAA KOTEY M.D

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTRAL ST
CHILLICOTHEE MO
64601-1554
US

IV. Provider business mailing address

707 N ORANGE ST
CAMERON MO
64429-1804
US

V. Phone/Fax

Practice location:
  • Phone: 660-707-4291
  • Fax:
Mailing address:
  • Phone: 630-518-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2012003457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: