Provider Demographics
NPI:1417215252
Name:KWAKYE, KWABENA A (MD)
Entity Type:Individual
Prefix:
First Name:KWABENA
Middle Name:A
Last Name:KWAKYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0998
Mailing Address - Country:US
Mailing Address - Phone:605-782-8305
Mailing Address - Fax:
Practice Address - Street 1:2100 S MARION RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3646
Practice Address - Country:US
Practice Address - Phone:605-322-1010
Practice Address - Fax:605-322-1011
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA43876207R00000X
SDSD207R00000X
SD8483207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine