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NPI Code Detail

MEDICARE: ESSENTIAL INTEGRATIVE MEDICINE LLC

MEDICARE: ESSENTIAL INTEGRATIVE MEDICINE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianME 84580FL
2208D00000XGeneral Practice PhysicianPA 9104287FL
3208D00000XGeneral Practice PhysicianOS10332FL

General Provider Information

NPI Number : 1134470255
Entity Type Code : Organization
Provider Name (Legal Business Name) : ESSENTIAL INTEGRATIVE MEDICINE LLC
Provider Business Mailing Address
First Line : 3715 W AZEELE ST
Second Line :
City : TAMPA
State : FL
Zip : 33609-2807
Country : US
Telephone Number : 813-253-0711
Fax Number : 813-253-0411
Provider Business Practice Location Address
First Line : 3715 W AZEELE ST
Second Line :
City : TAMPA
State : FL
Zip : 33609-2807
Country : US
Telephone Number : 813-253-0711
Fax Number : 813-253-0411
Authorized Official
Title or Position : PRESIDENT
Name : DR. TAN THANG TRAN
Credential : D.C.
Telephone Number : 813-253-0711
Provider Enumeration Date : 09/28/2012
Last Update Date : 03/12/2015

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1275109514 — DR. MATTHEW RYAN KILGAS DC
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Directions to “ESSENTIAL INTEGRATIVE MEDICINE LLC ” Practice Location

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