Provider Demographics
NPI:1023153962
Name:FAMILY MEDICAL CLINIC OF HILLSBOROUGH COUNTY INC.
Entity type:Organization
Organization Name:FAMILY MEDICAL CLINIC OF HILLSBOROUGH COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKUND
Authorized Official - Middle Name:CHATURBHAI
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-877-7773
Mailing Address - Street 1:3120 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5927
Mailing Address - Country:US
Mailing Address - Phone:813-877-7773
Mailing Address - Fax:813-877-3771
Practice Address - Street 1:3120 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5927
Practice Address - Country:US
Practice Address - Phone:813-877-7773
Practice Address - Fax:813-877-3771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62437 DR SHAH207R00000X
FLME58029 DR AMIN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370423800Medicaid
FL24879Medicare ID - Type Unspecified