Provider Demographics
NPI:1033767017
Name:OMNI FAMILY MEDICAL SC
Entity Type:Organization
Organization Name:OMNI FAMILY MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KWESI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT-ACQUAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-374-9575
Mailing Address - Street 1:7810 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-4518
Mailing Address - Country:US
Mailing Address - Phone:414-586-9255
Mailing Address - Fax:414-760-6219
Practice Address - Street 1:7810 W GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-4518
Practice Address - Country:US
Practice Address - Phone:414-586-9255
Practice Address - Fax:414-760-6219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNI FAMILY MEDICAL SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty