Healthcare Provider Details

I. General information

NPI: 1043257215
Provider Name (Legal Business Name): ALFRED ASANTE-KORANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH ST S 2ND FLR, DEPT 7130
ST PETERSBURG FL
33701-4630
US

IV. Provider business mailing address

501 6TH ST S 2ND FLR, DEPT 7130
ST PETERSBURG FL
33701-4630
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-3333
  • Fax: 727-767-8990
Mailing address:
  • Phone: 727-767-3333
  • Fax: 727-767-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number71301
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: