Provider Demographics
NPI:1629064001
Name:WIREDU, AKUA (MD)
Entity Type:Individual
Prefix:
First Name:AKUA
Middle Name:
Last Name:WIREDU
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 1:1685 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-6422
Mailing Address - Country:US
Mailing Address - Phone:727-442-0500
Mailing Address - Fax:727-442-0535
Practice Address - Street 1:611 DRUID RD E STE 511
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-442-0500
Practice Address - Fax:727-442-0535
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99798207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0471260001Medicare NSC
H09464Medicare UPIN
FLAG417ZMedicare PIN
FL279526400Medicaid
007057442Medicare PIN