Unknown Individual – Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician, NPI 1073612495

Unknown Individual is a healthcare provider. based in Brandon, Florida. specializing in Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician. They hold a License No. ME 27045 (FL). The NPI Number for Unknown Individual is 1073612495

Main info

Organization
Inactive
64 Years Of Experience
Name
Unknown Individual
NPI
1073612495
Phone
(813) 654-4466
Address
165 W ROBERTSON ST
Deactivation Date
17 August 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8136544466
Graduation Year
1962 (64 years ago)
PAC ID
5698734747
Professional Enrollment ID
I20041005001086
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 165, West Robertson Street, Brandon, Hillsborough County, Florida, 33511, United States

    BRANDON, FL 335115111

    Phone: (813) 654-4466

    Fax: (813) 684-5500

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

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Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33511)

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Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1073612495.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
Which specialty label fits Unknown Individual?
NPPES ties Unknown Individual to Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
Is Unknown Individual tied to Brandon, Florida?
If you are local to Brandon, Florida, Unknown Individual may be relevant to your search.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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