Healthcare Provider Details

I. General information

NPI: 1184914418
Provider Name (Legal Business Name): KEVIN JOHN WHITWORTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 HARBOR VILLAGE LN
APOLLO BEACH FL
33572-3483
US

IV. Provider business mailing address

720 BROOKER CREEK BLVD STE 215
OLDSMAR FL
34677-2937
US

V. Phone/Fax

Practice location:
  • Phone: 813-493-1779
  • Fax: 813-641-3821
Mailing address:
  • Phone: 813-854-2003
  • Fax: 813-436-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME128124
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: