Provider Demographics
NPI:1245792878
Name:BOAKYE, ANITA AMMA AKOMAA (DO)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:AMMA AKOMAA
Last Name:BOAKYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 RILEY HOSPITAL DR # 230
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5119
Mailing Address - Country:US
Mailing Address - Phone:317-274-2563
Mailing Address - Fax:
Practice Address - Street 1:699 RILEY HOSPITAL DR # 230
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5119
Practice Address - Country:US
Practice Address - Phone:317-274-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016667207R00000X, 208000000X
390200000X
IN02007894A2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program