Provider Demographics
NPI:1588830756
Name:ONYIAH, COMFORT C (MD MPH)
Entity Type:Individual
Prefix:
First Name:COMFORT
Middle Name:C
Last Name:ONYIAH
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 WHITE OAK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1580 WHITE OAK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2919
Practice Address - Country:US
Practice Address - Phone:952-544-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN570282083P0901X, 207Q00000X
MDD0071839207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN57028OtherMINNESOTA LICENSE NUMBER
MDD0071839OtherMARYLAND LICENCE NUMBER