Provider Demographics
NPI:1053634865
Name:THE CENTER FOR INTERNAL MEDICINE INC
Entity type:Organization
Organization Name:THE CENTER FOR INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-863-5449
Mailing Address - Street 1:701 W. MARTIN LUTHER KING JR. BLVD.,
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 W. MARTIN LUTHER KING JR. BLVD.,
Practice Address - Street 2:SUITE 6
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3100
Practice Address - Country:US
Practice Address - Phone:727-232-8700
Practice Address - Fax:727-232-8703
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CENTER FOR INTERNAL MEDICINE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036726207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL51132WMedicare PIN