Healthcare Provider Details

I. General information

NPI: 1497707947
Provider Name (Legal Business Name): DEEPAK K NAIDU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E KENNEDY BLVD 410
TAMPA FL
33602-5181
US

IV. Provider business mailing address

201 E KENNEDY BLVD 410
TAMPA FL
33602-5181
US

V. Phone/Fax

Practice location:
  • Phone: 813-434-1620
  • Fax: 813-434-1621
Mailing address:
  • Phone: 813-434-1620
  • Fax: 813-434-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME110564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: