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General NPI Number Information
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NPI Number | 1720131667
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Entity Type | Organization
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Legal Business Name | A. KORANTENG MEDICAL LTD
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 419 RIDGEMOOR DR
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5418
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Country | US
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Telephone | 630-794-0276
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Fax |
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Provider Business Mailing Address
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Address Line | 419 RIDGEMOOR DR
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City | WILLOWBROOK
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State | IL
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Zip | 60527-5418
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Country | US
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Telephone | 630-794-0276
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMA FORDWOR-KORANTENG
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Credential | MD
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Telephone | 630-794-0276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 036102134
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License Number State | IL
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