Provider Demographics
NPI:1821088352
Name:KPADENOU, SAMSON K (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:K
Last Name:KPADENOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 BARCLAY CIR STE 105
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5803
Mailing Address - Country:US
Mailing Address - Phone:586-731-8200
Mailing Address - Fax:586-731-8922
Practice Address - Street 1:75 BARCLAY CIR STE 105
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5803
Practice Address - Country:US
Practice Address - Phone:586-731-8200
Practice Address - Fax:586-731-8922
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2114646Medicaid
66300161111Medicare ID - Type Unspecified
MI2114646Medicaid