Provider Demographics
NPI:1548420227
Name:ANNESE, ANTHONY P (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:P
Last Name:ANNESE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1608 SE 3RD AVENUE
Mailing Address - Street 2:THIRD FLOOR PBO
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-785-0300
Mailing Address - Fax:954-785-0229
Practice Address - Street 1:1 W SAMPLE ROAD
Practice Address - Street 2:SUITE 204
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3547
Practice Address - Country:US
Practice Address - Phone:954-785-0300
Practice Address - Fax:954-785-0229
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2016-10-10
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Provider Licenses
StateLicense IDTaxonomies
MA237076207R00000X
MN56797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018019000Medicaid
FLBOUE5OtherFL BLUE
FLBOUE5OtherFL BLUE