MEDICARE: KRUPESH DAVE

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	ME153624	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

General Provider Information

NPI Number	:	1821592239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRUPESH DAVE

Provider Business Mailing Address
First Line	:	20 BROOKVIEW CIR
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29605-3042
Country	:	US
Telephone Number	:	856-381-6585
Fax Number	:

Provider Business Practice Location Address
First Line	:	8396 COMPASS ROSE DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6314
Country	:	US
Telephone Number	:	856-381-6585
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	07/03/2023

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Directions to “ KRUPESH DAVE ” Practice Location

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