Provider Demographics
NPI:1811933369
Name:OTENG, KWABENA OWUSU (MD)
Entity type:Individual
Prefix:DR
First Name:KWABENA
Middle Name:OWUSU
Last Name:OTENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:935 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1911
Mailing Address - Country:US
Mailing Address - Phone:513-831-5955
Mailing Address - Fax:513-831-5985
Practice Address - Street 1:360 GLENSPRINGS DR
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-2304
Practice Address - Country:US
Practice Address - Phone:513-671-5050
Practice Address - Fax:513-671-3012
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-5421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI25964Medicare UPIN
OHOT4152882Medicare ID - Type UnspecifiedDUCO MILFORD
OHOT4152884Medicare ID - Type UnspecifiedDUCO KETTERING
OHOT4152885Medicare ID - Type UnspecifiedDUCO DAYTON
OHOT4152886Medicare ID - Type UnspecifiedDUCO COLERAIN
OHOT4152882Medicare ID - Type UnspecifiedDUCO MILFORD
OHOT4152887Medicare ID - Type UnspecifiedDUCO FAIRBORN
OHI25964Medicare UPIN