MEDICARE: PHOENIX PEDIATRICS OF BROWARD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619970498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PEDIATRICS OF BROWARD LLC

Provider Business Mailing Address
First Line	:	PO BOX 80328
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19101-1328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S ANDREWS AVE
Second Line	:	PHOENIX PEDIATRICS
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-2510
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:	877-250-6889

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER KENNEDY
Credential	:
Telephone Number	:	207-807-9009

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/01/2025

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