Provider Demographics
NPI:1912264284
Name:OPPONG, CLETUS KOBIAH (MD)
Entity type:Individual
Prefix:DR
First Name:CLETUS
Middle Name:KOBIAH
Last Name:OPPONG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 MEADOWHILL LN
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:KY
Mailing Address - Zip Code:42376-9066
Mailing Address - Country:US
Mailing Address - Phone:812-483-1323
Mailing Address - Fax:812-289-3473
Practice Address - Street 1:2272 MEADOWHILL LN
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:KY
Practice Address - Zip Code:42376-9066
Practice Address - Country:US
Practice Address - Phone:812-483-1323
Practice Address - Fax:812-289-3473
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY534132083P0500X, 2083X0100X
GA73916208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY63228OtherALBANY MEDICAL CENTER