Provider Demographics
NPI:1629030747
Name:KIRINDONGO, EDU ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:EDU ANTHONY
Middle Name:
Last Name:KIRINDONGO
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:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-698-3720
Mailing Address - Fax:689-698-3720
Practice Address - Street 1:280 WEKIVA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-5946
Practice Address - Country:US
Practice Address - Phone:407-788-2273
Practice Address - Fax:407-389-2273
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67264207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37790100Medicaid
FL377790100Medicaid
FLG02975Medicare PIN
FL27186HMedicare UPIN