Healthcare Provider Details

I. General information

NPI: 1710023940
Provider Name (Legal Business Name): STELLAR ANONYE ACHAMPONG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DR
SISSETON SD
57262-7046
US

IV. Provider business mailing address

PO BOX 100
SISSETON SD
57262-0100
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax: 605-698-7606
Mailing address:
  • Phone: 605-698-7606
  • Fax: 605-742-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01028192A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: