Healthcare Provider Details

I. General information

NPI: 1164984365
Provider Name (Legal Business Name): SYLVIA OWUSU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIA ANSAH-ABOAGYE

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date: 11/07/2019
Reactivation Date: 11/27/2019

III. Provider practice location address

744 S WEBSTER AVE
GREEN BAY WI
54301-3505
US

IV. Provider business mailing address

1199 PRINCE AVE # 70
ATHENS GA
30606
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-3500
  • Fax:
Mailing address:
  • Phone: 706-475-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number77016-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: