Healthcare Provider Details

I. General information

NPI: 1003017724
Provider Name (Legal Business Name): AKUA GYANEWAH ASARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

400 NE 137TH ST APT 306
NORTH MIAMI FL
33161-3775
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-8264
  • Fax:
Mailing address:
  • Phone: 412-445-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN10675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: