Healthcare Provider Details

I. General information

NPI: 1083611776
Provider Name (Legal Business Name): ANIS Y AKRAWI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SE RIVERSIDE DR STE 203
STUART FL
34994-2579
US

IV. Provider business mailing address

PO BOX 417
STUART FL
34995-0417
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1555
  • Fax: 772-287-2140
Mailing address:
  • Phone: 772-223-5665
  • Fax: 772-223-5646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number60733
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number60733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: