Healthcare Provider Details

I. General information

NPI: 1962509133
Provider Name (Legal Business Name): KOSMAS M SARANTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 MEMORIAL HWY
TAMPA FL
33634-7332
US

IV. Provider business mailing address

5535 MEMORIAL HWY
TAMPA FL
33634-7332
US

V. Phone/Fax

Practice location:
  • Phone: 813-574-4869
  • Fax: 813-341-4159
Mailing address:
  • Phone: 813-574-4869
  • Fax: 813-341-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME39672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: