Provider Demographics
NPI:1962492363
Name:KEWESHAN, WILLIAM THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:KEWESHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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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
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067399400Medicaid
FL82243ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FL067399400Medicaid
FLE32186Medicare UPIN