1669054300 NPI number — KOSSI KEKLE TETE MD

Table of content: KOSSI KEKLE TETE MD (NPI 1669054300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669054300 NPI number — KOSSI KEKLE TETE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TETE
Provider First Name:
KOSSI
Provider Middle Name:
KEKLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1669054300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9746 LAKE CHRISE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34668-4021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-679-1313
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAPTIST HEALTH INTERNAL MEDICINE CLINIC
Provider Second Line Business Practice Location Address:
3201 SPRINGHILL DR SUITE 100
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-955-4530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2021

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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