Healthcare Provider Details

I. General information

NPI: 1992996557
Provider Name (Legal Business Name): KINGSWAY MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N PARSONS AVE SUITE 102A
BRANDON FL
33510-4537
US

IV. Provider business mailing address

407 N PARSONS AVE SUITE 102A
BRANDON FL
33510-4537
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-5807
  • Fax: 813-655-9817
Mailing address:
  • Phone: 813-655-5807
  • Fax: 813-655-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME59296
License Number StateFL

VIII. Authorized Official

Name: DR. ANILKUMAR R PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 813-655-5807