Provider Demographics
NPI:1689751950
Name:TAMPA MEDICAL PARTNERS INC.
Entity Type:Organization
Organization Name:TAMPA MEDICAL PARTNERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUDO
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:727-375-9700
Mailing Address - Street 1:8140 PICTON WAY
Mailing Address - Street 2:ST#103
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1792
Mailing Address - Country:US
Mailing Address - Phone:727-375-9700
Mailing Address - Fax:727-375-9720
Practice Address - Street 1:8140 PICTON WAY
Practice Address - Street 2:ST#103
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1792
Practice Address - Country:US
Practice Address - Phone:727-375-9700
Practice Address - Fax:727-375-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6009208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043965700Medicaid
FL1295732642OtherNPI GARY R LEVINE DO
FLK1810OtherMEDICARE TAMPA MEDICAL PARTNERS ID
FL043965700Medicaid
FL1295732642OtherNPI GARY R LEVINE DO
E32310Medicare UPIN
FL043965700Medicare ID - Type UnspecifiedGARY R LEVINE DO