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General NPI Number Information
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NPI Number | 1265734263
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Entity Type | Organization
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Legal Business Name | SHREEKANT TRIPATHI, M.D., P.A.
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 520 E GARDEN ST
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City | LAKELAND
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State | FL
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Zip | 33805-4616
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Country | US
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Telephone | 863-688-0536
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Fax | 863-688-0639
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Provider Business Mailing Address
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Address Line | 520 E GARDEN ST
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City | LAKELAND
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State | FL
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Zip | 33805-4616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHREEKANT K TRIPATHI
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Credential | M.D.
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Telephone | 863-688-0536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME 42352
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License Number State | FL
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