Provider Demographics
NPI:1760461388
Name:ADDO, FERDINAND E K (MD)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:E K
Last Name:ADDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:F.E.K.
Other - Middle Name:
Other - Last Name:ADDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:401 9TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-1548
Mailing Address - Country:US
Mailing Address - Phone:605-882-6800
Mailing Address - Fax:605-882-6831
Practice Address - Street 1:401 9TH AVE NW
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-1548
Practice Address - Country:US
Practice Address - Phone:605-882-6800
Practice Address - Fax:605-882-6831
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6234207RH0003X
SD9624207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDC88988Medicare UPIN
NDN24015Medicare PIN