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