Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME100646 | FL |
NPI | 1013100825 |
---|---|
Provider Name | Kaivon Madani |
First Address | Tampa, FL 33606-3508 |
Second Address | Tampa, FL 33606-3508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2007 |
Last Update Date | 27/04/2011 |