Healthcare Provider Details

I. General information

NPI: 1598034852
Provider Name (Legal Business Name): HITEN UPADHYAY MDPL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 4TH ST N SUITE C
ST PETERSBURG FL
33702-6822
US

IV. Provider business mailing address

PO BOX 7941
ST PETERSBURG FL
33734-7941
US

V. Phone/Fax

Practice location:
  • Phone: 727-528-7827
  • Fax: 727-528-7667
Mailing address:
  • Phone: 727-528-7827
  • Fax: 727-528-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME80430
License Number StateFL

VIII. Authorized Official

Name: DR. HITEN J UPADHYAY
Title or Position: PRESIDENT
Credential: MD
Phone: 727-528-7827