MEDICARE: MITCHELL CHECKVER DO PA

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	261Q00000X	Clinic/Center	0S4309	FL

General Provider Information

NPI Number	:	1831408954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL CHECKVER DO PA

Provider Business Mailing Address
First Line	:	7211 N DALE MABRY HWY
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33614-2669
Country	:	US
Telephone Number	:	813-933-2841
Fax Number	:	813-915-0326

Provider Business Practice Location Address
First Line	:	7211 N DALE MABRY HWY
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33614-2669
Country	:	US
Telephone Number	:	813-933-2841
Fax Number	:	813-915-0326

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. JENNIFER L CONNELLY
Credential	:
Telephone Number	:	813-933-2841

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	03/12/2014

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