Healthcare Provider Details

I. General information

NPI: 1114155611
Provider Name (Legal Business Name): JONATHAN KESHISHIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 N HABANA AVE
TAMPA FL
33607-6546
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-0951
  • Fax: 813-443-8140
Mailing address:
  • Phone: 727-281-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME112275
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: