Healthcare Provider Details

I. General information

NPI: 1003835000
Provider Name (Legal Business Name): ANUKWARE KETOSUGBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 NOSTRAND AVE
BROOKLYN NY
11225-5532
US

IV. Provider business mailing address

PO BOX 5619
NEW YORK NY
10087-5619
US

V. Phone/Fax

Practice location:
  • Phone: 718-622-1301
  • Fax: 718-622-1367
Mailing address:
  • Phone: 718-622-1301
  • Fax: 718-622-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number147545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: