Provider Demographics
NPI:1194926501
Name:NTIM, KWAME SAFO (MD)
Entity type:Individual
Prefix:
First Name:KWAME
Middle Name:SAFO
Last Name:NTIM
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 1:3004 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:407-593-2910
Mailing Address - Fax:407-593-2913
Practice Address - Street 1:3004 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6011
Practice Address - Country:US
Practice Address - Phone:407-593-2910
Practice Address - Fax:407-593-2913
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114943207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008982700Medicaid
FL008982700Medicaid
FLHJ893ZMedicare PIN