Provider Demographics
NPI:1730568080
Name:AKAGI FUKUSHIMA, ELISA FUMI (MD)
Entity type:Individual
Prefix:MS
First Name:ELISA
Middle Name:FUMI
Last Name:AKAGI FUKUSHIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 E MCANDREWS RD STE 160
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5590
Mailing Address - Country:US
Mailing Address - Phone:541-732-6070
Mailing Address - Fax:
Practice Address - Street 1:1698 E MCANDREWS RD STE 160
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-732-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD204223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500797738Medicaid