Healthcare Provider Details

I. General information

NPI: 1093200420
Provider Name (Legal Business Name): VINCENT ADJETEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

IV. Provider business mailing address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-3771
  • Fax: 701-842-6248
Mailing address:
  • Phone: 701-842-3771
  • Fax: 701-842-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17144
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: