Provider Demographics
NPI:1609404011
Name:PACHOLEC, KEVIN
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:PACHOLEC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 2ND AVE N STE 510
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3395
Mailing Address - Country:US
Mailing Address - Phone:727-502-2000
Mailing Address - Fax:
Practice Address - Street 1:150 2ND AVE N STE 510
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3395
Practice Address - Country:US
Practice Address - Phone:727-502-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine