Provider Demographics
NPI:1285636811
Name:NAKANISHI, KEI (MD)
Entity Type:Individual
Prefix:DR
First Name:KEI
Middle Name:
Last Name:NAKANISHI
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 1:3114 CROASDAILE DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2508
Mailing Address - Country:US
Mailing Address - Phone:919-425-1565
Mailing Address - Fax:919-425-0478
Practice Address - Street 1:1600 S ANDREWS AVENUE
Practice Address - Street 2:PHOENIX OB/GYN, LLC
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2510
Practice Address - Country:US
Practice Address - Phone:954-355-5110
Practice Address - Fax:954-355-4919
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76076207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259485400Medicaid
FL43847RMedicare PIN
FL259485400Medicaid