MEDICARE: PRINCE KWABLA PEKYI-BOATENG MD

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	2084N0400X	Neurology Physician	14244924-1205	UT

General Provider Information

NPI Number	:	1558107474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCE KWABLA PEKYI-BOATENG MD

Provider Business Mailing Address
First Line	:	30 N 1900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84132-0002
Country	:	US
Telephone Number	:	801-581-2401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2553 E NEFFS LN
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-4029
Country	:	US
Telephone Number	:	385-478-7577
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2024
Last Update Date	:	10/29/2025

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