Provider Demographics
NPI:1154530707
Name:KURT B. REPKE, M.D., P.A.
Entity type:Organization
Organization Name:KURT B. REPKE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:REPKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-736-7873
Mailing Address - Street 1:1965 COVE LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6426
Mailing Address - Country:US
Mailing Address - Phone:727-736-7873
Mailing Address - Fax:727-736-7905
Practice Address - Street 1:646 VIRGINIA ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6612
Practice Address - Country:US
Practice Address - Phone:727-736-7873
Practice Address - Fax:727-736-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079899207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49801DMedicare ID - Type Unspecified
FLG27455Medicare UPIN