MEDICARE: ANELEY YEGEZU HUNDAE 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	207R00000X	Internal Medicine Physician	ME106485	FL
2	207RC0000X	Cardiovascular Disease Physician	ME106485	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659551356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANELEY YEGEZU HUNDAE MD

Provider Business Mailing Address
First Line	:	3161 HARBOR BLVD STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6754
Country	:	US
Telephone Number	:	941-235-8892
Fax Number	:	941-883-4494

Provider Business Practice Location Address
First Line	:	3161 HARBOR BLVD STE A
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6754
Country	:	US
Telephone Number	:	941-235-8892
Fax Number	:	941-883-4494

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

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	01/23/2019

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