Basic Information
| Provider Information | |||||||||
| NPI: | 1346745338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AKWARI | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | KESANDU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1109 S PLEASANT VALLEY RD APT 311 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787411887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814687651 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2409 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787121112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124711737 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2018 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.