Provider Demographics
NPI:1356925440
Name:ANKOMAH, KOFI (NP)
Entity type:Individual
Prefix:
First Name:KOFI
Middle Name:
Last Name:ANKOMAH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 W BYRON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-2712
Mailing Address - Country:US
Mailing Address - Phone:224-866-9641
Mailing Address - Fax:773-282-2163
Practice Address - Street 1:4840 W BYRON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2712
Practice Address - Country:US
Practice Address - Phone:773-282-7800
Practice Address - Fax:773-282-2163
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2023032820363LP0808X
IL2021013060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily