Provider Demographics
NPI:1356794564
Name:YEBOAH, KEVIN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:YEBOAH
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 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:972-566-5411
Mailing Address - Fax:972-519-8337
Practice Address - Street 1:TRINITY HEALTH IHA MEDICAL GROUP NEUROLOGY OAKLAND
Practice Address - Street 2:44555 WOODWARD AVENUE, SUITE 104
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5032
Practice Address - Country:US
Practice Address - Phone:248-858-6104
Practice Address - Fax:248-858-6115
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXT01502084V0102X
390200000X
MI43015098392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program