Healthcare Provider Details

I. General information

NPI: 1831187640
Provider Name (Legal Business Name): MOSHE KEDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 DRUID RD E SUITE 306
CLEARWATER FL
33756-3959
US

IV. Provider business mailing address

611 DRUID RD E SUITE 306
CLEARWATER FL
33756-3959
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-3761
  • Fax: 727-443-0768
Mailing address:
  • Phone: 727-441-3761
  • Fax: 727-443-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME24699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: