Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Main Street Medical LLC

Organization Adult Medicine Physician · NPI 1487079505

Main Street Medical LLC is an Adult Medicine Physician in Tampa, Florida. Works from 2 locations. Registered with an NPI since 2014.

In the registry since
2014
Specialties on file
5
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

10549 N Florida Ave Ste A
Tampa, FL 33612-6707
Phone: (813) 220-1400
Fax: (813) 440-6484
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 6506 Embassy Blvd, Port Richey, FL 34668-4734 — (727) 387-8228

Specialties & licences

Primary Care Clinic/Center (primary) Taxonomy 261QP2300X
Adult Medicine Physician Taxonomy 207QA0505X
Addiction Medicine (Psychiatry & Neurology) Physician Taxonomy 2084A0401X
Psychiatry Physician Taxonomy 2084P0800X
Mental Health Clinic/Center (Including Community Mental Health Center) Taxonomy 261QM0801X

Record details

NPI number1487079505
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Stephen Banjoko — Cfo · (212) 257-0225
Other names Main Street Medical Centers
NPI enumeratedFebruary 26, 2014
Last updated in NPPESOctober 3, 2024
Certification dateOctober 3, 2024
Mailing addressPo Box 17175, Tampa, FL 33682-7175

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