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General NPI Number Information
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NPI Number | 1457218596
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Entity Type | Organization
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Legal Business Name | PROMED IPA LLC
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 3301 66TH ST N STE A
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City | ST PETERSBURG
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State | FL
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Zip | 33710-1547
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Country | US
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Telephone | 727-344-6200
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Fax | 727-344-6222
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Provider Business Mailing Address
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Address Line | 3301 66TH ST N STE A
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City | ST PETERSBURG
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State | FL
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Zip | 33710-1547
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Country | US
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Telephone | 727-344-6200
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Fax | 727-344-6222
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PANEENDRA TIRUPATHI
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Credential |
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Telephone | 727-492-5699
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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 |
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License Number State |
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