Provider Demographics
NPI:1669054300
Name:TETE, KOSSI KEKLE (MD)
Entity type:Individual
Prefix:
First Name:KOSSI
Middle Name:KEKLE
Last Name:TETE
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 1:3500 ARENDELL ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2901
Mailing Address - Country:US
Mailing Address - Phone:813-679-1313
Mailing Address - Fax:
Practice Address - Street 1:BAPTIST HEALTH INTERNAL MEDICINE CLINIC
Practice Address - Street 2:3201 SPRINGHILL DR SUITE 100
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117
Practice Address - Country:US
Practice Address - Phone:501-955-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2024-02052208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program