Provider Demographics
NPI:1437610896
Name:AKPAN, EDIDIONG (MD)
Entity Type:Individual
Prefix:
First Name:EDIDIONG
Middle Name:
Last Name:AKPAN
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:HENRY FORD HOSPITAL, MEDICAL EDUCATION DEPARTMENT
Mailing Address - Street 2:2799 W. GRAND BOULEVARD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-874-5378
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD STE 450
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1968
Practice Address - Country:US
Practice Address - Phone:410-553-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD95083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine