MEDICARE: SAGE PEDIATRICS PA

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	261QP2300X	Primary Care Clinic/Center	ME 71575	FL

General Provider Information

NPI Number	:	1710147533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE PEDIATRICS PA

Provider Business Mailing Address
First Line	:	1990 NE 163RD STREET
Second Line	:	SUITE # 101
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4854
Country	:	US
Telephone Number	:	305-949-1275
Fax Number	:	305-949-1273

Provider Business Practice Location Address
First Line	:	1990 NE 163RD ST
Second Line	:	SUITE # 101
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4854
Country	:	US
Telephone Number	:	305-949-1275
Fax Number	:	305-949-1273

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLAKUNLE T OLAGBEMI
Credential	:	M.D.
Telephone Number	:	305-949-1275

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	06/16/2008

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Directions to “SAGE PEDIATRICS PA ” Practice Location

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