1083779490 NPI number — DR. GILLIAN KAY KARATINOS M.D.

Table of content: DR. GILLIAN KAY KARATINOS M.D. (NPI 1083779490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083779490 NPI number — DR. GILLIAN KAY KARATINOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARATINOS
Provider First Name:
GILLIAN
Provider Middle Name:
KAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KARATINOS
Provider Other First Name:
JILL
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1083779490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15823 FAIRCHILD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33647-1123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-977-9919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15310 AMBERLY DR
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33647-2199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-977-9919
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  ME69122 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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