1235174996 NPI number — DR. ANNIE AGBOR ARREY MENSAH MD

Table of content: DR. ANNIE AGBOR ARREY MENSAH MD (NPI 1235174996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235174996 NPI number — DR. ANNIE AGBOR ARREY MENSAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARREY MENSAH
Provider First Name:
ANNIE
Provider Middle Name:
AGBOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235174996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29355 NORTHWESTERN HWY
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48034-1045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-396-9563
Provider Business Mailing Address Fax Number:
248-304-8906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27155 HAMPSTEAD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-396-9563
Provider Business Practice Location Address Fax Number:
248-304-8906
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  4301069914 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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