Healthcare Provider Details

I. General information

NPI: 1447926027
Provider Name (Legal Business Name): CLEARWATER CARDIOVASCULAR AND INTERVENTIONAL CONSULTANTS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8839 BRYAN DAIRY RD STE 300
LARGO FL
33777-1207
US

IV. Provider business mailing address

455 PINELLAS ST STE 400
CLEARWATER FL
33756-3356
US

V. Phone/Fax

Practice location:
  • Phone: 727-394-1911
  • Fax: 727-394-1986
Mailing address:
  • Phone: 727-445-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN B MAIR
Title or Position: CEO
Credential:
Phone: 727-445-1992