Provider Demographics
NPI:1528121647
Name:OPOKU-OWUSU, OWUSU-BEKOE (MD)
Entity type:Individual
Prefix:
First Name:OWUSU-BEKOE
Middle Name:
Last Name:OPOKU-OWUSU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OWUSU-BEKOE
Other - Middle Name:
Other - Last Name:OPOKU-OWUSU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:920-288-8100
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:920-288-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62417207RI0200X
WI62417-20282N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100038836Medicaid
KY64130081Medicaid