Healthcare Provider Details

I. General information

NPI: 1285196956
Provider Name (Legal Business Name): IN HOME PODIATRY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7532 CLEARVIEW DR
TAMPA FL
33634-2930
US

IV. Provider business mailing address

7532 CLEARVIEW DR
TAMPA FL
33634-2930
US

V. Phone/Fax

Practice location:
  • Phone: 813-525-6135
  • Fax:
Mailing address:
  • Phone: 813-525-6135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIBIBI DAVISON
Title or Position: PRESIDENT
Credential: DPM
Phone: 813-525-6135