Provider Demographics
NPI:1215040621
Name:BABU, KESHAVA H (MD)
Entity Type:Individual
Prefix:DR
First Name:KESHAVA
Middle Name:H
Last Name:BABU
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 1:208 W. MARTIN LUTHER KING JR. BLVD.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603
Mailing Address - Country:US
Mailing Address - Phone:813-221-8131
Mailing Address - Fax:813-221-8138
Practice Address - Street 1:208 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3602
Practice Address - Country:US
Practice Address - Phone:813-221-8131
Practice Address - Fax:813-221-8138
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME737762080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL201050937OtherTAX-ID
FL253439800Medicaid