MEDICARE: DR. KEI NAKANISHI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME76076	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285636811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEI NAKANISHI MD

Provider Business Mailing Address
First Line	:	3114 CROASDAILE DRIVE
Second Line	:	SUITE 200
City	:	DURHAM
State	:	NC
Zip	:	27705-2508
Country	:	US
Telephone Number	:	919-425-1565
Fax Number	:	919-425-0478

Provider Business Practice Location Address
First Line	:	1600 S ANDREWS AVENUE
Second Line	:	PHOENIX OB/GYN, LLC
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-2510
Country	:	US
Telephone Number	:	954-355-5110
Fax Number	:	954-355-4919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/15/2010

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