Healthcare Provider Details

I. General information

NPI: 1821298779
Provider Name (Legal Business Name): CHRISTOPHER G RESTREPO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 06/02/2023
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 W SAINT ISABEL ST
TAMPA FL
33607-6318
US

IV. Provider business mailing address

2502 W SAINT ISABEL ST
TAMPA FL
33607-6318
US

V. Phone/Fax

Practice location:
  • Phone: 813-874-5707
  • Fax:
Mailing address:
  • Phone: 813-874-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.30192
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.30192
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL29779
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME115551
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: