Provider Demographics
NPI:1407025067
Name:KWASI OPUNI BOAKYE, M.D., P.C.
Entity Type:Organization
Organization Name:KWASI OPUNI BOAKYE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KWASI
Authorized Official - Middle Name:OPUNI
Authorized Official - Last Name:BOAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-437-7800
Mailing Address - Street 1:30 S HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1820
Mailing Address - Country:US
Mailing Address - Phone:517-437-7800
Mailing Address - Fax:517-437-7825
Practice Address - Street 1:30 S HOWELL ST
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1820
Practice Address - Country:US
Practice Address - Phone:517-437-7800
Practice Address - Fax:517-437-7825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071567173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01398OtherHEALTH PLAN OF MI
MI1017386OtherBHSJHP
MI900044182OtherPRIORITY HEALTH
MI103452147Medicaid
MI110038200001OtherBLUE CARE NETWORK
MIKB071567OtherPHYSICIAN LICENSE #
MI200000003904OtherPHP
MI10321OtherGREAT LAKES HEALTH PLAN
MI106651OtherGLHP
MI1103000361OtherBLUE CROSS BLUE SHIELD
MI1103000361OtherBLUE CROSS BLUE SHIELD
MI200000003904OtherPHP
MI1017386OtherBHSJHP