Provider Demographics
NPI:1245319243
Name:ANTHONY KIRINDONGO MD CORP
Entity type:Organization
Organization Name:ANTHONY KIRINDONGO MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRINDONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-963-3637
Mailing Address - Street 1:3175 S CONGRESS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2562
Mailing Address - Country:US
Mailing Address - Phone:561-963-3637
Mailing Address - Fax:561-963-3638
Practice Address - Street 1:3175 S CONGRESS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2562
Practice Address - Country:US
Practice Address - Phone:561-963-3637
Practice Address - Fax:561-963-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3033Medicare ID - Type Unspecified