Basic Information
| Provider Information | |||||||||
| NPI: | 1467688812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATIEMO | ||||||||
| FirstName: | KOFI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1430 TULANE AVE # 8622 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049885128 | ||||||||
| FaxNumber: | 5049881838 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 TULANE AVE FL 6 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049885110 | ||||||||
| FaxNumber: | 5049880644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2009 | ||||||||
| LastUpdateDate: | 10/01/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 036139737 | IL | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 320612 | LA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MT195694 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 204F00000X | 320612 | LA | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
No ID Information.