MEDICARE: MR. KIRTI J PANDYA M.D.

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
1	2084P0800X	Psychiatry Physician	59291	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568408870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIRTI J PANDYA M.D.

Provider Business Mailing Address
First Line	:	5106 N ARMENIA AVE
Second Line	:	#3
City	:	TAMPA
State	:	FL
Zip	:	33603-1433
Country	:	US
Telephone Number	:	813-353-0900
Fax Number	:	813-353-0802

Provider Business Practice Location Address
First Line	:	5106 N ARMENIA AVE
Second Line	:	#3
City	:	TAMPA
State	:	FL
Zip	:	33603-1433
Country	:	US
Telephone Number	:	813-353-0900
Fax Number	:	813-353-0802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/07/2008

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