Organization

Citrus Park Medical

Legal Business Name

Citrus Park Medical

NPI Number

1134334790

NPI Type

Organization

Enumeration Date

05/14/2007

Specialties

(Taxonomies)

Code

207Q00000X
207R00000X

Primary Taxonomy

No
No

Licenses

State

Florida

License Number

ME50876

Contact
Information

Purpose

Mailing
Location

Address

6328 GUNN HWY
6328 GUNN HWY

City

Tampa
Tampa

State

FL
FL

Postal Code

33625-4122
33625-4122

Country

US
US

Telephone Number

(813) 343-5500
(813) 343-5500

Authorized Official

Name

Dr. Dipak Shah

Title or Position

DOCTOR

Telephone Number

(813) 343-5500

Identifiers

Identifier

03966
206018
00291
04953
228737

Identifier State

FL
FL
FL
FL
FL

Identifier Issuer

BCBS
AVMED
STAYWELL
UNIVERSAL MEDICAL
AMERIGROUP

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/22/2020

Provider Address