| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 13121 66th St, Largo, Florida |
| Authorized Official Name and Position | Carrie L Shulman (PRESIDENT) |
| Authorized Official Contact | 7273148180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
13121 66th St Largo FL 33773-1812 Ph: (727) 314-8180 | 13121 66th St Largo FL 33773-1812 Ph: (727) 314-8180 |
| NPI Number | 1588151906 |
|---|---|
| Provider Enumeration Date | 04/20/2018 |
| Last Update Date | 04/20/2018 |
| Medicare PECOS PAC ID | 5991053001 |
|---|---|
| Medicare Enrollment ID | O20180807000955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588151906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Carrie L Shulman |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1225017833 PECOS PAC ID: 6103821988 Enrollment ID: I20171002000640 |
| Provider Name | Kathryn B Gerlach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699147967 PECOS PAC ID: 5597061275 Enrollment ID: I20190711000053 |
| Provider Name | Pradeep K Narotam |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1821109786 PECOS PAC ID: 7214039981 Enrollment ID: I20200826003437 |
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