Healthcare Provider Details

I. General information

NPI: 1598178899
Provider Name (Legal Business Name): ECG TAMPA BAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

3000 MEDICAL PARK DR #500
TAMPA FL
33613-4680
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-2424
  • Fax: 813-971-2420
Mailing address:
  • Phone: 813-971-2424
  • Fax: 813-971-2420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN L KLEIN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 813-971-2424