MEDICARE: IN HOME PODIATRY SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO4035	OTHER	FL	PODIATRIC LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285196956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME PODIATRY SC

Provider Business Mailing Address
First Line	:	7532 CLEARVIEW DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2930
Country	:	US
Telephone Number	:	813-525-6135
Fax Number	:

Provider Business Practice Location Address
First Line	:	7532 CLEARVIEW DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2930
Country	:	US
Telephone Number	:	813-525-6135
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIBIBI DAVISON
Credential	:	DPM
Telephone Number	:	813-525-6135

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	02/10/2020

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Directions to “IN HOME PODIATRY SC ” Practice Location

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