Healthcare Provider Details

I. General information

NPI: 1215040621
Provider Name (Legal Business Name): KESHAVA H BABU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33603-3602
US

IV. Provider business mailing address

208 W. MARTIN LUTHER KING JR. BLVD.
TAMPA FL
33603
US

V. Phone/Fax

Practice location:
  • Phone: 813-221-8131
  • Fax: 813-221-8138
Mailing address:
  • Phone: 813-221-8131
  • Fax: 813-221-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME73776
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: