Healthcare Provider Details

I. General information

NPI: 1720078454
Provider Name (Legal Business Name): KWASI PRAKAH-ASANTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR SUITE 606
JACKSONVILLE FL
32207-8210
US

IV. Provider business mailing address

851 TRAFALGAR CT. SUITE 200E
MAITLAND FL
32751
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-3356
  • Fax: 904-398-5397
Mailing address:
  • Phone: 407-667-0444
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036096985
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036096985
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036096985
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME75977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: