MEDICARE: KIDSTOWN PEDIATRICS, 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	74168	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730215112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDSTOWN PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	7800 SW 87TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33173-3570
Country	:	US
Telephone Number	:	954-731-9676
Fax Number	:	954-731-9747

Provider Business Practice Location Address
First Line	:	211 NE 89TH ST
Second Line	:
City	:	EL PORTAL
State	:	FL
Zip	:	33138-3119
Country	:	US
Telephone Number	:	305-576-5437
Fax Number	:	305-576-5120

Authorized Official
Title or Position	:	MD
Name	:	MARGARET OKONKWO
Credential	:	MD
Telephone Number	:	305-576-5437

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	10/16/2017

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Directions to “KIDSTOWN PEDIATRICS, LLC ” Practice Location

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