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General NPI Number Information
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NPI Number | 1912264284
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Entity Type | Individual
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Provider Name | CLETUS KOBIAH OPPONG M.D
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Gender | Male
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 05/04/2025
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Provider Practice Location Address
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Address Line | 2272 MEADOWHILL LN
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City | UTICA
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State | KY
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Zip | 42376-9066
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Country | US
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Telephone | 812-483-1323
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Fax | 812-289-3473
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Provider Business Mailing Address
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Address Line | 2272 MEADOWHILL LN
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City | UTICA
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State | KY
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Zip | 42376-9066
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Country | US
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Telephone | 812-483-1323
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Fax | 812-289-3473
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 53413
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 73916
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 53413
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License Number State | KY
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