MEDICARE: AMPONSAH BUSINESS AND MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME99944	FL

General Provider Information

NPI Number	:	1386175487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPONSAH BUSINESS AND MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	4409 HOFFNER AVE
Second Line	:	#121
City	:	ORLANDO
State	:	FL
Zip	:	32812-2331
Country	:	US
Telephone Number	:	321-356-3043
Fax Number	:

Provider Business Practice Location Address
First Line	:	4409 HOFFNER AVE
Second Line	:	#121
City	:	ORLANDO
State	:	FL
Zip	:	32812-2331
Country	:	US
Telephone Number	:	321-356-3043
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL AMPONSAH
Credential	:	MD
Telephone Number	:	321-356-3043

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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