Provider Demographics
NPI:1124446075
Name:DOCTOR ON DUTY, LLC
Entity type:Organization
Organization Name:DOCTOR ON DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EBRAHIM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KARKEVANDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-814-4900
Mailing Address - Street 1:12187 W LINEBAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1732
Mailing Address - Country:US
Mailing Address - Phone:813-814-4900
Mailing Address - Fax:813-814-4900
Practice Address - Street 1:12187 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1732
Practice Address - Country:US
Practice Address - Phone:813-814-4900
Practice Address - Fax:813-814-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL07000066511OtherDOCUMENT NUMBER