Healthcare Provider Details

I. General information

NPI: 1447694971
Provider Name (Legal Business Name): ENDOCRINOLOGY CONSULTANTS OF ST. PETERSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 5TH AVE N
ST PETERSBURG FL
33713-7218
US

IV. Provider business mailing address

4820 5TH AVE N
ST PETERSBURG FL
33713-7218
US

V. Phone/Fax

Practice location:
  • Phone: 727-321-6768
  • Fax: 727-327-8741
Mailing address:
  • Phone: 727-321-6768
  • Fax: 727-327-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0050422
License Number StateFL

VIII. Authorized Official

Name: DR. GOVINDAN POTTETH NAIR
Title or Position: CEO
Credential: M.D.
Phone: 727-321-6768