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General NPI Number Information
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NPI Number | 1669687612
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Entity Type | Individual
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Provider Name | ELI KOLP MD
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Gender | Male
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 1604 3RD STREET CIR E
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City | PALMETTO
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State | FL
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Zip | 34221
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Country | US
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Telephone | 727-798-8379
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Fax |
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Provider Business Mailing Address
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Address Line | 6151 OSPREY LAKE DRIVE SUITE A
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City | SARASOTA
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State | FL
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Zip | 34240-8419
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Country | US
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Telephone | 941-202-1947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME 53667
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C172835
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License Number State | CA
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