Provider Demographics
NPI:1790855732
Name:ADDY, NII TETTEH TSURU (DO)
Entity Type:Individual
Prefix:DR
First Name:NII TETTEH
Middle Name:TSURU
Last Name:ADDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:615 W MERMOD ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4912
Mailing Address - Country:US
Mailing Address - Phone:575-887-8925
Mailing Address - Fax:575-887-8935
Practice Address - Street 1:615 W MERMOD ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4912
Practice Address - Country:US
Practice Address - Phone:575-887-8925
Practice Address - Fax:575-887-8935
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA1299-05207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI26832Medicare UPIN