Healthcare Provider Details

I. General information

NPI: 1982341426
Provider Name (Legal Business Name): OFORIWAA BEDIAKO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 KOLBE RD
LORAIN OH
44053-1611
US

IV. Provider business mailing address

2020 SUMMERLAND LN APT 2
EDINBURG TX
78541-0736
US

V. Phone/Fax

Practice location:
  • Phone: 419-681-3796
  • Fax:
Mailing address:
  • Phone: 972-502-0518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.007540RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: