Healthcare Provider Details

I. General information

NPI: 1437357555
Provider Name (Legal Business Name): KEVIN A ACHE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 9TH AVE N STE 110
ST PETERSBURG FL
33713-7147
US

IV. Provider business mailing address

2191 9TH AVE N STE 110
ST PETERSBURG FL
33713-7147
US

V. Phone/Fax

Practice location:
  • Phone: 727-820-7778
  • Fax: 727-820-7779
Mailing address:
  • Phone: 727-820-7778
  • Fax: 727-820-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS10676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: