MEDICARE: FIRST KNIGHT MEDICAL INC

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	ME0068819	FL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME0068819	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	:	1780655647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST KNIGHT MEDICAL INC

Provider Business Mailing Address
First Line	:	8508 ALAFIA HILLS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3408
Country	:	US
Telephone Number	:	813-650-8600
Fax Number	:	813-650-8664

Provider Business Practice Location Address
First Line	:	8508 ALAFIA HILLS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3408
Country	:	US
Telephone Number	:	813-650-8600
Fax Number	:	813-650-8664

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. LAURENCE MILTON PETTY
Credential	:	M.D.
Telephone Number	:	813-650-8600

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/10/2013

Similar Medicare Providers

1265655757 — DR. LAURENCE MILTON PETTY M.D.
Practice Location Address:

8508 ALAFIA HILLS DR
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1508290883 — MS. CHRISTINA DENICE RODGERS NP-C
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1942372073 — DR. SATISHCHANDRA V DHOLAKIA MD
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1194909358 — MRS. YVONNE E SHAKES
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Directions to “FIRST KNIGHT MEDICAL INC ” Practice Location

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