Provider Demographics
NPI:1194776054
Name:ACKERMANN, ALAN (DO)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:ACKERMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:20803 BISCAYNE BLVD STE 204
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1429
Practice Address - Country:US
Practice Address - Phone:954-265-7900
Practice Address - Fax:954-265-0266
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 7303207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261292500OtherFLORIDA MEDICAID
FL2511023OtherCIGNA
FL044569OtherNHP
FL290491OtherAVMED
FL51320OtherBCBS
FLP000446577OtherRAILROAD MEDICARE
FL290491OtherAVMED