Provider Demographics
NPI:1083655906
Name:AWA, PAUL KAZUHIKO (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:KAZUHIKO
Last Name:AWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862506
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-2506
Mailing Address - Country:US
Mailing Address - Phone:913-754-0467
Mailing Address - Fax:913-341-5797
Practice Address - Street 1:2901 W SWANN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4056
Practice Address - Country:US
Practice Address - Phone:913-754-0467
Practice Address - Fax:913-341-5797
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88109207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29105OtherBCBS
FL281246100Medicaid
FL29105OtherBCBS
FL29105ZMedicare PIN
FL$$$$$$$$$OtherCHAMPUS/TRICARE
FL29105XMedicare PIN