Provider Demographics
NPI:1962419531
Name:KAKI, A K (MD)
Entity type:Individual
Prefix:DR
First Name:A
Middle Name:K
Last Name:KAKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S DEANE DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3818
Mailing Address - Country:US
Mailing Address - Phone:863-983-5453
Mailing Address - Fax:863-983-2059
Practice Address - Street 1:406 S DEANE DUFF AVE
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3818
Practice Address - Country:US
Practice Address - Phone:863-983-5453
Practice Address - Fax:863-983-2059
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27027Medicare PIN