Provider Demographics
NPI:1013922814
Name:ACQUAH, EKOW E (MD)
Entity Type:Individual
Prefix:
First Name:EKOW
Middle Name:E
Last Name:ACQUAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:EKOW
Other - Last Name:ACQUAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2101 HIGHWAY 90 FL 4
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:228-497-8869
Practice Address - Street 1:15200 COMMUNITY RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3085
Practice Address - Country:US
Practice Address - Phone:228-575-7112
Practice Address - Fax:228-575-7190
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242907208M00000X
MS15951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013922814Medicaid
MS00119697Medicaid
P00749929Medicare PIN
MS302I116309Medicare PIN
VAVVM067B288Medicare PIN