Provider Information for 1023605664
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EMMANUEL OPPONG
Sex: Male
NPI: 1023605664
Last Updated: 2020-12-29
Certification Date: 2020-12-29
Certification Date: 2020-12-29
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1023605664 | ||||||||
| Enumeration Date | 2020-12-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 2041 SAINT CLOUD, MN 56302-2041 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 22 WILSON AVE NE STE 209 SAINT CLOUD, MN 56304-0440 United States Phone: 320-237-6996 | Fax: | ||||||||
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