Healthcare Provider Details

I. General information

NPI: 1225034986
Provider Name (Legal Business Name): YARED AKLILU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 N FEDERAL HWY STE 200
FT LAUDERDALE FL
33308-4609
US

IV. Provider business mailing address

4750 N FEDERAL HWY STE 200
FT LAUDERDALE FL
33308-4609
US

V. Phone/Fax

Practice location:
  • Phone: 954-489-2260
  • Fax: 954-489-2261
Mailing address:
  • Phone: 954-489-2260
  • Fax: 954-489-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME73773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: