Individual
GLENN A KWIAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3301 W GANDY BLVD, TAMPA, FL 33611-2931
(813) 925-1903
Mailing address
1428 PARILLA CIR, TRINITY, FL 34655-7052
(727) 207-7630
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
35.057132
OH
207Q00000X
Family Medicine Physician
Primary
ME100907
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000297500
—
FL
05
—
0724890
—
OH
05
—
121267800
—
FL
01
—
53648
BLUE CROSS/BLUE SHIELD OF FLORIDA
FL
01
—
P00807421
MEDICARE RAILROAD
FL
05
—
PENDING
—
FL
Enumeration date
05/24/2006
Last updated
12/27/2024
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