Provider Demographics
NPI:1588165773
Name:DEEPAK NAIDU MD, PA
Entity type:Organization
Organization Name:DEEPAK NAIDU MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:K
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-434-1620
Mailing Address - Street 1:201 E KENNEDY BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3641
Mailing Address - Country:US
Mailing Address - Phone:813-434-1620
Mailing Address - Fax:813-434-1621
Practice Address - Street 1:201 E KENNEDY BLVD STE 410
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3641
Practice Address - Country:US
Practice Address - Phone:813-434-1620
Practice Address - Fax:813-434-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1105642086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty