MEDICARE: DR. MITCHELL DAVID CHECKVER D.O.

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	207Q00000X	Family Medicine Physician	OS0004309	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	592962653	OTHER		TAX ID

General Provider Information

NPI Number	:	1881642650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL DAVID CHECKVER D.O.

Provider Business Mailing Address
First Line	:	7211 N DALE MABRY HWY
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33614-2669
Country	:	US
Telephone Number	:	813-933-2841
Fax Number	:	813-915-0326

Provider Business Practice Location Address
First Line	:	7211 N DALE MABRY HWY
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33614-2669
Country	:	US
Telephone Number	:	813-933-2841
Fax Number	:	813-915-0326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/30/2010

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