Provider Demographics
NPI:1659367951
Name:THAMPY, KISHORE J (MD)
Entity Type:Individual
Prefix:
First Name:KISHORE
Middle Name:J
Last Name:THAMPY
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 1:4446 HENDRICKS AVE STE 134
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-6369
Mailing Address - Country:US
Mailing Address - Phone:904-315-2242
Mailing Address - Fax:904-212-0424
Practice Address - Street 1:3599 UNIVERSITY BLVD S STE 1200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4288
Practice Address - Country:US
Practice Address - Phone:833-443-8700
Practice Address - Fax:904-642-9108
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1053612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL260025865OtherRAILROAD MEDICARE
IA1133389Medicaid
IAP00134680OtherRAILROAD MEDICARE
IL0216041OtherBLUE SHIELD
IL036048133Medicaid
IL0216041OtherBLUE SHIELD
IL472441Medicare ID - Type Unspecified
IAP00134680OtherRAILROAD MEDICARE
IL036048133Medicaid
IL214253Medicare PIN