Basic Information
| Provider Information | |||||||||
| NPI: | 1629030747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIRINDONGO | ||||||||
| FirstName: | EDU ANTHONY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 AMBERFIELD DR, STE 104 | ||||||||
| Address2: | |||||||||
| City: | LAND O'LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135367285 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34650 US HIGHWAY 19 N STE 104 | ||||||||
| Address2: | |||||||||
| City: | PALM HARBOR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272334895 | ||||||||
| FaxNumber: | 7274004712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2006 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME67264 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 377790100 | 05 | FL | MEDICAID | 37790100 | 05 | FL | MEDICAID |