Provider Demographics
NPI:1083026868
Name:KANAROGLOU, ANDRONIKI (MD)
Entity Type:Individual
Prefix:
First Name:ANDRONIKI
Middle Name:
Last Name:KANAROGLOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:KANAROGLOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 SAWGRASS CORPORATE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2823
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-527-5510
Practice Address - Street 1:10301 HAGEN RANCH RD
Practice Address - Street 2:SUITE C130
Practice Address - City:BOYTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-736-7313
Practice Address - Fax:561-736-2309
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
FLME1202352088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011989900Medicaid