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General NPI Number Information
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NPI Number | 1821116468
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Entity Type | Organization
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Legal Business Name | K A BOATENG MD FACOG PC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 2000 GLENWOOD AVE LOWER LEVEL EAST
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City | JOLIET
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State | IL
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Zip | 60435-5676
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Country | US
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Telephone | 815-553-0500
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Fax | 815-553-0505
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Provider Business Mailing Address
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Address Line | 2000 GLENWOOD AVE LOWER LEVEL EAST
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City | JOLIET
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State | IL
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Zip | 60435-5676
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Country | US
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Telephone | 815-553-0500
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Fax | 815-553-0505
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KWABENA A BOATENG
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Credential | MD
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Telephone | 815-553-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | IL
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