Provider Demographics
NPI:1619389897
Name:ACHAMPONG, NANA SIRIBOE (MD)
Entity Type:Individual
Prefix:DR
First Name:NANA
Middle Name:SIRIBOE
Last Name:ACHAMPONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:572 BEACON LAKE DR
Mailing Address - Street 2:APT 8
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1972
Mailing Address - Country:US
Mailing Address - Phone:517-402-4006
Mailing Address - Fax:
Practice Address - Street 1:965 FEE ROAD, ROOM A233
Practice Address - Street 2:MICHIGAN STATE UNIVERSITY AND AFFILIATED HOSPITALS
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-432-2993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011054812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry