Provider Demographics
NPI:1972714632
Name:ANSAARIE, IMRAAN (MD)
Entity type:Individual
Prefix:DR
First Name:IMRAAN
Middle Name:
Last Name:ANSAARIE
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 1:209 PINEHURST POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3703
Mailing Address - Country:US
Mailing Address - Phone:773-412-3420
Mailing Address - Fax:
Practice Address - Street 1:215 HWY 17S
Practice Address - Street 2:
Practice Address - City:EAST PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32131
Practice Address - Country:US
Practice Address - Phone:773-412-3420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME121178207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012828200Medicaid
IN200902590Medicaid
IN146470E6OtherMEDICARE
IN200902590Medicaid
IN146470E6OtherMEDICARE