MEDICARE: ANUKWARE KETOSUGBO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	147545	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003835000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANUKWARE KETOSUGBO MD

Provider Business Mailing Address
First Line	:	PO BOX 5619
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-5619
Country	:	US
Telephone Number	:	929-790-6922
Fax Number	:	718-622-1367

Provider Business Practice Location Address
First Line	:	1143 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5532
Country	:	US
Telephone Number	:	929-790-6922
Fax Number	:	718-622-1367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	04/30/2026

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