Provider Demographics
NPI:1265499289
Name:OWUSU DEKYI, KWABENA (MD)
Entity type:Individual
Prefix:DR
First Name:KWABENA
Middle Name:
Last Name:OWUSU DEKYI
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:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9354
Mailing Address - Country:US
Mailing Address - Phone:314-953-6801
Mailing Address - Fax:314-953-6819
Practice Address - Street 1:1225 GRAHAM RD STE C-2320
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8030
Practice Address - Country:US
Practice Address - Phone:314-953-6801
Practice Address - Fax:314-953-6819
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000503207Q00000X
OH35071227O207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2086059Medicaid
OH2086059Medicaid
P00058033Medicare PIN
OHG78323Medicare UPIN
OH0854796Medicare PIN