Provider Demographics
NPI:1821116468
Name:K A BOATENG MD FACOG PC
Entity Type:Organization
Organization Name:K A BOATENG MD FACOG PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-553-0500
Mailing Address - Street 1:2000 GLENWOOD AVE
Mailing Address - Street 2:LOWER LEVEL EAST
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5676
Mailing Address - Country:US
Mailing Address - Phone:815-553-0500
Mailing Address - Fax:815-553-0505
Practice Address - Street 1:2000 GLENWOOD AVE
Practice Address - Street 2:LOWER LEVEL EAST
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5676
Practice Address - Country:US
Practice Address - Phone:815-553-0500
Practice Address - Fax:815-553-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205993Medicare ID - Type Unspecified
ILF32971Medicare UPIN