Healthcare Provider Details

I. General information

NPI: 1164771531
Provider Name (Legal Business Name): KEISHA ADAMS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 813-821-8038
  • Fax: 813-974-4325
Mailing address:
  • Phone: 813-821-8038
  • Fax: 813-974-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME152250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: