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General NPI Number Information
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NPI Number | 1285196956
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Entity Type | Organization
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Legal Business Name | IN HOME PODIATRY SC
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 02/10/2020
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Provider Practice Location Address
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Address Line | 7532 CLEARVIEW DR
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City | TAMPA
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State | FL
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Zip | 33634-2930
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Country | US
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Telephone | 813-525-6135
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Fax |
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Provider Business Mailing Address
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Address Line | 7532 CLEARVIEW DR
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City | TAMPA
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State | FL
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Zip | 33634-2930
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Country | US
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Telephone | 813-525-6135
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIBIBI DAVISON
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Credential | DPM
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Telephone | 813-525-6135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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