Provider Demographics
NPI:1184617276
Name:NENONENE, KWASI A (MD)
Entity type:Individual
Prefix:DR
First Name:KWASI
Middle Name:A
Last Name:NENONENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8769 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1392
Mailing Address - Country:US
Mailing Address - Phone:937-275-6341
Mailing Address - Fax:937-275-6342
Practice Address - Street 1:8769 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1392
Practice Address - Country:US
Practice Address - Phone:937-275-6341
Practice Address - Fax:937-275-6342
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2286093Medicaid
OH2286093Medicaid
OHSP03431Medicare PIN