Healthcare Provider Details

I. General information

NPI: 1811184583
Provider Name (Legal Business Name): VIPUL JOSHI, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 PROVIDENCE RD
BRANDON FL
33511-4885
US

IV. Provider business mailing address

PO BOX 1192
BRANDON FL
33509-1192
US

V. Phone/Fax

Practice location:
  • Phone: 813-651-4441
  • Fax: 813-661-3374
Mailing address:
  • Phone: 813-651-4441
  • Fax: 813-661-3374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME87414
License Number StateFL

VIII. Authorized Official

Name: VIPUL JOSHI
Title or Position: PRESIDENT
Credential: MD
Phone: 813-651-4441