Provider Demographics
NPI:1265839377
Name:KANEKU NAGAHAMA, HUGO KEIJI (MD)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:KEIJI
Last Name:KANEKU NAGAHAMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUGO
Other - Middle Name:
Other - Last Name:KANEKU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 NW 10TH AVE RM 8149
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1015
Mailing Address - Country:US
Mailing Address - Phone:305-243-9462
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 10TH AVE RM 8149
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1015
Practice Address - Country:US
Practice Address - Phone:305-243-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME141946207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program