Healthcare Provider Details

I. General information

NPI: 1730179441
Provider Name (Legal Business Name): DIPAK DINANATH NADKARNI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 2ND AVE SW
LARGO FL
33770-2298
US

IV. Provider business mailing address

1301 2ND AVE SW
LARGO FL
33770-2298
US

V. Phone/Fax

Practice location:
  • Phone: 727-581-8767
  • Fax: 727-586-6018
Mailing address:
  • Phone: 727-581-8767
  • Fax: 727-586-6018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0006974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: