Provider Demographics
NPI:1295845550
Name:KWITKO, GEOFFREY MALCOM (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:MALCOM
Last Name:KWITKO
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 1:608 S TAMPANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4143
Mailing Address - Country:US
Mailing Address - Phone:813-877-8665
Mailing Address - Fax:813-877-9479
Practice Address - Street 1:608 S TAMPANIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4143
Practice Address - Country:US
Practice Address - Phone:813-877-8665
Practice Address - Fax:813-877-9479
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59247207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE73208Medicare UPIN
FL11743Medicare ID - Type Unspecified