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General NPI Number Information
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NPI Number | 1598495376
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Entity Type | Organization
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Legal Business Name | KETAN TRIVEDI MD, PLLC
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Dates
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Enumeration Date | 06/14/2022
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Last Update Date | 06/14/2022
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Provider Practice Location Address
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Address Line | 4760 TAMIAMI TRL N STE 24
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City | NAPLES
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State | FL
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Zip | 34103-3065
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Country | US
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Telephone | 239-331-4870
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Fax | 239-315-4915
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Provider Business Mailing Address
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Address Line | 4422 CALDERA CIR
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City | NAPLES
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State | FL
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Zip | 34119-9057
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Country | US
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Telephone | 901-734-9924
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Fax | 239-315-4915
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KETAN TRIVEDI
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Credential | MD
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Telephone | 901-734-9924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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