Healthcare Provider Details

I. General information

NPI: 1194955328
Provider Name (Legal Business Name): KWAME APPIAGYEI ENNIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 W PARKER RD STE 470
PLANO TX
75093-8338
US

IV. Provider business mailing address

6020 W PARKER RD STE 470
PLANO TX
75093-8338
US

V. Phone/Fax

Practice location:
  • Phone: 972-608-8868
  • Fax: 972-608-0366
Mailing address:
  • Phone: 972-608-8868
  • Fax: 972-608-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberP3712
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberP3712
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: