Provider Demographics
NPI:1629206701
Name:CHAZHIKATTU, AMBROSE JOHN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:AMBROSE JOHN
Middle Name:JOSEPH
Last Name:CHAZHIKATTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:508 S HABANA AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4144
Mailing Address - Country:US
Mailing Address - Phone:813-877-6770
Mailing Address - Fax:813-877-6771
Practice Address - Street 1:608 S TAMPANIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4143
Practice Address - Country:US
Practice Address - Phone:813-844-6770
Practice Address - Fax:813-844-6771
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine