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General NPI Number Information
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NPI Number | 1316229545
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Entity Type | Organization
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Legal Business Name | TAMPA PHYSICIANS GROUP
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 6709 RIDGE RD
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City | PORT RICHEY
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State | FL
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Zip | 34668-6834
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Country | US
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Telephone | 832-236-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 2643 CALDWELL RD NE
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City | ATLANTA
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State | GA
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Zip | 30319-3118
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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 | CEO
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Name | DR. RAKESH KOTHARI
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Credential | D.C.
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Telephone | 832-236-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME 105419
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License Number State | FL
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