Provider Demographics
NPI:1629054952
Name:DANKWA, VIBEKE O (MD)
Entity Type:Individual
Prefix:MRS
First Name:VIBEKE
Middle Name:O
Last Name:DANKWA
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 1:3174 CUSTER DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4000
Mailing Address - Country:US
Mailing Address - Phone:859-272-4882
Mailing Address - Fax:859-273-3916
Practice Address - Street 1:3174 CUSTER DR
Practice Address - Street 2:STE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4000
Practice Address - Country:US
Practice Address - Phone:859-272-4882
Practice Address - Fax:859-273-3916
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64027527Medicaid
KY0692904Medicare ID - Type Unspecified
KY0905206Medicare ID - Type Unspecified
KY0693004Medicare ID - Type Unspecified
H34213Medicare UPIN
KY64027527Medicaid