Provider Demographics
NPI:1578264313
Name:ACCIMEUS, WALAS
Entity Type:Individual
Prefix:MR
First Name:WALAS
Middle Name:
Last Name:ACCIMEUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13100 NE 7TH AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7535
Mailing Address - Country:US
Mailing Address - Phone:786-366-0061
Mailing Address - Fax:
Practice Address - Street 1:13100 NE 7TH AVE APT 114
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7535
Practice Address - Country:US
Practice Address - Phone:786-366-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant