Provider Demographics
NPI:1558040055
Name:ADDAI, MARK AMOAKO
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:AMOAKO
Last Name:ADDAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6270 CALLISBURG DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-0037
Mailing Address - Country:US
Mailing Address - Phone:646-552-1432
Mailing Address - Fax:
Practice Address - Street 1:6270 CALLISBURG DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-0037
Practice Address - Country:US
Practice Address - Phone:646-552-1432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUF742607347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle