Provider Demographics
NPI:1437231065
Name:KANKOTIA, JERAMBHAI T (MD)
Entity Type:Individual
Prefix:
First Name:JERAMBHAI
Middle Name:T
Last Name:KANKOTIA
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 1:1939 HIGHLAND OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7323
Mailing Address - Country:US
Mailing Address - Phone:813-948-1234
Mailing Address - Fax:813-949-8408
Practice Address - Street 1:1939 HIGHLAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7323
Practice Address - Country:US
Practice Address - Phone:813-948-1234
Practice Address - Fax:813-949-8408
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0048194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056226200Medicaid
FL056226200Medicaid
E97278Medicare UPIN