Healthcare Provider Details

I. General information

NPI: 1336594316
Provider Name (Legal Business Name): PEDIATRIC CARDIOLOGY SPECIALISTS PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
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 DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33603-3602
US

V. Phone/Fax

Practice location:
  • Phone: 813-223-3300
  • Fax:
Mailing address:
  • Phone: 813-223-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KESHAVA BABU
Title or Position: MD
Credential:
Phone: 813-223-3300