Provider Demographics
NPI:1588659551
Name:BOAKYE, KWASI O (MD, FACE)
Entity Type:Individual
Prefix:DR
First Name:KWASI
Middle Name:O
Last Name:BOAKYE
Suffix:
Gender:M
Credentials:MD, FACE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S HOWELL ST
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1883
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:49242-1883
Practice Address - Country:US
Practice Address - Phone:517-437-7800
Practice Address - Fax:517-437-7825
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071567207R00000X, 173000000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103452147Medicaid
MIP96983OtherBLUE CARE NETWORK
MIKB071567OtherPHYSICIAN LICENSE #
MI0420164OtherPHP
MI10321OtherGLHP
MI1103000361OtherBLUE CROSS BLUE SHIELD OF
MI23D0957778OtherCLIA#
MI23D0957778OtherCLIA#
MI0420164OtherPHP
MI1103000361OtherBLUE CROSS BLUE SHIELD OF