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NPI Code Detail

MEDICARE: KEVIN D FRADKIN M.D.

MEDICARE: KEVIN D FRADKIN 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
1208600000XSurgery Physician44107CO
2208600000XSurgery PhysicianME178121FL
3208600000XSurgery Physician12654NV
4202K00000XPhlebology PhysicianM4071TX
5208600000XSurgery PhysicianM4071TX
6174400000XSpecialistM4071TX

General Provider Information

NPI Number : 1972603934
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN D FRADKIN M.D.
Provider Business Mailing Address
First Line : 3820 NORTHDALE BLVD STE 201
Second Line :
City : TAMPA
State : FL
Zip : 33624-1893
Country : US
Telephone Number : 800-991-6117
Fax Number :
Provider Business Practice Location Address
First Line : 11221 KATY FWY STE 201
Second Line :
City : HOUSTON
State : TX
Zip : 77079-2105
Country : US
Telephone Number : 800-991-6117
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 01/09/2026

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