Healthcare Provider Details

I. General information

NPI: 1467541953
Provider Name (Legal Business Name): KEVIN J. MAKATI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 VAN DYKE ROAD SUITE 205
LUTZ FL
33558
US

IV. Provider business mailing address

4211 VAN DYKE ROAD SUITE 205
LUTZ FL
33558
US

V. Phone/Fax

Practice location:
  • Phone: 813-229-9292
  • Fax: 813-229-9293
Mailing address:
  • Phone: 813-229-9292
  • Fax: 813-229-9293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number101255
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number101255
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number220117
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number101255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: