Healthcare Provider Details

I. General information

NPI: 1861714354
Provider Name (Legal Business Name): ALL CARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10013 N FLORIDA AVE
TAMPA FL
33612-7410
US

IV. Provider business mailing address

10013 N FLORIDA AVE
TAMPA FL
33612-7410
US

V. Phone/Fax

Practice location:
  • Phone: 813-443-4545
  • Fax: 813-443-4542
Mailing address:
  • Phone: 813-443-4545
  • Fax: 813-443-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberMM23949
License Number StateFL

VIII. Authorized Official

Name: MR. KENNETH COLLADO
Title or Position: CEO
Credential:
Phone: 813-443-4545