Individual
KWABENA A BOATENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2321 N WISCONSIN AVE, PEORIA, IL 61603-5613
(309) 680-7600
(309) 681-4681
Mailing address
2214 N UNIVERSITY ST, PEORIA, IL 61604-3221
(309) 680-7669
(309) 681-8443
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036084514
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036084514
—
IL
Enumeration date
01/29/2007
Last updated
08/28/2020
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