Provider Demographics
NPI:1215039599
Name:RZADKOWOLSKY-RAOLI, ANNA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:RZADKOWOLSKY-RAOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 SW 64 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156
Mailing Address - Country:US
Mailing Address - Phone:305-301-3143
Mailing Address - Fax:305-558-6134
Practice Address - Street 1:6175 NW 153 ST
Practice Address - Street 2:#404
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014
Practice Address - Country:US
Practice Address - Phone:305-558-7400
Practice Address - Fax:305-558-6134
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 456922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D64004Medicare UPIN