Individual
KONAN EUGENE KOUASSI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
23077 GREENFIELD RD, STE 485, SOUTHFIELD, MI 48075
(248) 552-9050
(248) 552-1290
Mailing address
3231 CHRISTOPHER LN APT 318, KEEGO HARBOR, MI 48320-1352
(313) 283-8258
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005325
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477879492
—
MI
Enumeration date
04/15/2010
Last updated
03/01/2023
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