Provider Demographics
NPI:1356330864
Name:ADDY, AKUORKOR A (MD)
Entity Type:Individual
Prefix:MRS
First Name:AKUORKOR
Middle Name:A
Last Name:ADDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:733 ALGER ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3530
Mailing Address - Country:US
Mailing Address - Phone:616-243-9515
Mailing Address - Fax:616-243-1815
Practice Address - Street 1:733 ALGER ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3530
Practice Address - Country:US
Practice Address - Phone:616-243-9515
Practice Address - Fax:616-243-1815
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059998208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3163476Medicaid