Healthcare Provider Details

I. General information

NPI: 1174937247
Provider Name (Legal Business Name): AKIKO MINAMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BREWSTER ST
PAWTUCKET RI
02860-4474
US

IV. Provider business mailing address

111 BREWSTER ST
PAWTUCKET RI
02860-4474
US

V. Phone/Fax

Practice location:
  • Phone: 401-729-2258
  • Fax: 401-729-3343
Mailing address:
  • Phone: 401-729-2258
  • Fax: 401-729-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number273752
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: