Provider Demographics
NPI:1629030747
Name:KIRINDONGO, EDU ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:EDU ANTHONY
Middle Name:
Last Name:KIRINDONGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDU
Other - Middle Name:ANTHONY
Other - Last Name:KIRINDONGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:415 US HIGHWAY 1 STE D
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-3585
Mailing Address - Country:US
Mailing Address - Phone:561-842-5900
Mailing Address - Fax:
Practice Address - Street 1:415 US HIGHWAY 1 STE D
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33403-3585
Practice Address - Country:US
Practice Address - Phone:561-842-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2025-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67264207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377790100Medicaid
FL37790100Medicaid
FLG02975Medicare PIN
FL27186HMedicare UPIN