Provider Demographics
NPI:1912519224
Name:HEALTH & GLOW PRIMARY CARE & MED SPA LLC
Entity Type:Organization
Organization Name:HEALTH & GLOW PRIMARY CARE & MED SPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SWAPNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALLIKADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-832-4569
Mailing Address - Street 1:4331 S MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611
Mailing Address - Country:US
Mailing Address - Phone:813-832-4569
Mailing Address - Fax:833-974-2491
Practice Address - Street 1:4331 S MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611
Practice Address - Country:US
Practice Address - Phone:813-832-4569
Practice Address - Fax:833-974-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty