Provider Demographics
NPI:1154341535
Name:HARAKE, ALI ABBAS (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:ABBAS
Last Name:HARAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 E COMMERCIAL BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3754
Mailing Address - Country:US
Mailing Address - Phone:954-938-9949
Mailing Address - Fax:954-938-9956
Practice Address - Street 1:2021 E COMMERCIAL BLVD STE 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3754
Practice Address - Country:US
Practice Address - Phone:954-938-9949
Practice Address - Fax:954-938-9956
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256456400Medicaid
FL27667OtherBLUE CROSS AND BLUE SHIEL
FL27667XMedicare PIN
G15973Medicare UPIN