Provider Demographics
NPI:1972730836
Name:AMIN, KUNAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KUNAL
Middle Name:
Last Name:AMIN
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 1:1621 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5043
Mailing Address - Country:US
Mailing Address - Phone:727-353-8600
Mailing Address - Fax:727-205-2381
Practice Address - Street 1:1621 22ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5043
Practice Address - Country:US
Practice Address - Phone:727-353-8600
Practice Address - Fax:727-205-2381
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005571800Medicaid
FLGD628ZMedicare PIN
FLGD628YMedicare PIN
FLGD628XMedicare PIN