Provider Demographics
NPI:1497979561
Name:WILLIAM T KEWESHAN DO, PLLC.
Entity Type:Organization
Organization Name:WILLIAM T KEWESHAN DO, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KEWESHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-595-2534
Mailing Address - Street 1:12294 INDIAN ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3001
Mailing Address - Country:US
Mailing Address - Phone:727-595-2534
Mailing Address - Fax:727-595-5059
Practice Address - Street 1:12294 INDIAN ROCKS RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3001
Practice Address - Country:US
Practice Address - Phone:727-595-2534
Practice Address - Fax:727-595-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2192Medicare PIN