Healthcare Provider Details

I. General information

NPI: 1427331149
Provider Name (Legal Business Name): PEEYUSH GROVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

IV. Provider business mailing address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-6199
  • Fax: 136-616-3348
Mailing address:
  • Phone: 813-661-6199
  • Fax: 136-616-3348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-42095
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-42095
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number04-42095
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: