Provider Demographics
NPI:1386175487
Name:AMPONSAH BUSINESS AND MEDICAL GROUP, INC
Entity type:Organization
Organization Name:AMPONSAH BUSINESS AND MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMPONSAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-356-3043
Mailing Address - Street 1:4409 HOFFNER AVE
Mailing Address - Street 2:#121
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-2331
Mailing Address - Country:US
Mailing Address - Phone:321-356-3043
Mailing Address - Fax:
Practice Address - Street 1:4409 HOFFNER AVE
Practice Address - Street 2:#121
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-2331
Practice Address - Country:US
Practice Address - Phone:321-356-3043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty