Healthcare Provider Details

I. General information

NPI: 1528121647
Provider Name (Legal Business Name): OWUSU-BEKOE OPOKU-OWUSU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OWUSU-BEKOE OPOKU-OWUSU MD

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8100
  • Fax:
Mailing address:
  • Phone: 920-288-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number62417
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: