Provider Demographics
NPI:1518998715
Name:ANIM-ADDO, EDWARD K (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:K
Last Name:ANIM-ADDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:K
Other - Last Name:ANIM-ADDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 8000
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-833-4140
Mailing Address - Fax:561-833-4176
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 8000
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-833-4140
Practice Address - Fax:561-833-4176
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 101942207R00000X
MS15486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001068900Medicaid
FL001068900Medicaid
MSG53417Medicare UPIN