Provider Demographics
NPI:1053598615
Name:PREMPEH, OSEI BONSU (MD)
Entity type:Individual
Prefix:DR
First Name:OSEI
Middle Name:BONSU
Last Name:PREMPEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 CANAL ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6367
Mailing Address - Country:US
Mailing Address - Phone:504-975-0653
Mailing Address - Fax:
Practice Address - Street 1:2930 CANAL ST
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6367
Practice Address - Country:US
Practice Address - Phone:504-975-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1238856Medicaid
MS00950201Medicaid
MS00950201Medicaid
LA4N5486629Medicare PIN