Provider Demographics
NPI:1043274152
Name:KAPADIA, KETAN A (MD)
Entity Type:Individual
Prefix:
First Name:KETAN
Middle Name:A
Last Name:KAPADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12109 COUNTY ROAD 103
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-2951
Mailing Address - Country:US
Mailing Address - Phone:352-205-8981
Mailing Address - Fax:352-391-6498
Practice Address - Street 1:5747 38TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1925
Practice Address - Country:US
Practice Address - Phone:727-381-8667
Practice Address - Fax:727-345-1951
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79719208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
270800OtherAVMED
7427017OtherAETNA HMO
FL259097200Medicaid
340018171OtherMEDIARE RAILROAD
591226600OtherUNITED HEALTHCARE
3979095003OtherCIGNA
151914OtherWELLCARE
2357014OtherAETNA PPO
49832OtherBCBS FLORIDA
270800OtherAVMED
FL259097200Medicaid