Healthcare Provider Details

I. General information

NPI: 1104274620
Provider Name (Legal Business Name): KESHAV KUKREJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 66TH ST N STE 201
ST PETERSBURG FL
33709-4949
US

IV. Provider business mailing address

3001 EXECUTIVE DR STE 130
CLEARWATER FL
33762-5323
US

V. Phone/Fax

Practice location:
  • Phone: 727-345-5500
  • Fax: 727-343-3716
Mailing address:
  • Phone: 727-347-0005
  • Fax: 727-541-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME144943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: