Basic Information
| Provider Information | |||||||||
| NPI: | 1265488217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY MEDICAL CARE OF ST PETERSBURG | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3745 33RD ST N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337131556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275250006 | ||||||||
| FaxNumber: | 7275213694 | ||||||||
| Practice Location | |||||||||
| Address1: | 3745 33RD ST N | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337131556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275250006 | ||||||||
| FaxNumber: | 7275213694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAVINDRA | ||||||||
| AuthorizedOfficialFirstName: | CHITRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7275250006 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.