Provider Demographics
NPI:1104274620
Name:KUKREJA, KESHAV (MD)
Entity type:Individual
Prefix:
First Name:KESHAV
Middle Name:
Last Name:KUKREJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3001 EXECUTIVE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-5323
Mailing Address - Country:US
Mailing Address - Phone:727-347-0005
Mailing Address - Fax:727-541-6558
Practice Address - Street 1:3901 66TH ST N STE 201
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-4949
Practice Address - Country:US
Practice Address - Phone:727-345-5500
Practice Address - Fax:727-343-3716
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME144943207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113924700Medicaid