Provider Demographics
NPI:1215206792
Name:KOZHIMALA T. JOHN M.D. P.A.
Entity type:Organization
Organization Name:KOZHIMALA T. JOHN M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KOZHIMALA
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-782-6116
Mailing Address - Street 1:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33539-1617
Mailing Address - Country:US
Mailing Address - Phone:813-782-6116
Mailing Address - Fax:813-780-1051
Practice Address - Street 1:6340 FORT KING RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542
Practice Address - Country:US
Practice Address - Phone:813-782-6116
Practice Address - Fax:813-780-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23148207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1891890638OtherNPI (INDIVIDUAL)
FL058391000Medicaid
FL51086OtherBC/BS
FL058391000Medicaid
FLD55960Medicare UPIN