Healthcare Provider Details

I. General information

NPI: 1609296441
Provider Name (Legal Business Name): ANUM AHMED M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2014
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 CORTEZ RD W
BRADENTON FL
34210-3142
US

IV. Provider business mailing address

PO BOX 25487
SARASOTA FL
34277-2487
US

V. Phone/Fax

Practice location:
  • Phone: 941-357-5550
  • Fax: 941-792-7152
Mailing address:
  • Phone: 941-202-5342
  • Fax: 855-253-4836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME126448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: