Healthcare Provider Details

I. General information

NPI: 1679100689
Provider Name (Legal Business Name): KWAKU OPARE-SEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF INTERNAL MEDICINE HEALTH SCIENCE CENTER T16, ROOM 020
STONY BROOK NY
11790-8160
US

IV. Provider business mailing address

DEPARTMENT OF INTERNAL MEDICINE HEALTH SCIENCE CENTER T16, ROOM 020
STONY BROOK NY
11790-8160
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-7411
  • Fax:
Mailing address:
  • Phone: 631-444-7411
  • 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: