Provider Demographics
NPI:1124017413
Name:KANKAM, CHARITY AMBA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:AMBA
Last Name:KANKAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 ROCKSIDE RD
Mailing Address - Street 2:STE 365
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2316
Mailing Address - Country:US
Mailing Address - Phone:216-901-5706
Mailing Address - Fax:216-901-6201
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:STE 365
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2316
Practice Address - Country:US
Practice Address - Phone:216-901-5706
Practice Address - Fax:216-901-6201
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059430207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0791657Medicaid
B81845Medicare UPIN
OHKA0662623Medicare ID - Type Unspecified