Provider Demographics
NPI:1659824092
Name:BAISE, KOFI
Entity Type:Individual
Prefix:
First Name:KOFI
Middle Name:
Last Name:BAISE
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 1:5256 TAMARACK CIR E APT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-4553
Mailing Address - Country:US
Mailing Address - Phone:614-377-4231
Mailing Address - Fax:
Practice Address - Street 1:5256 TAMARACK CIR E APT C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-4553
Practice Address - Country:US
Practice Address - Phone:614-377-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health