Healthcare Provider Details

I. General information

NPI: 1063568855
Provider Name (Legal Business Name): HUNTCLUB PEDIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S HUNT CLUB BLVD STE 1051
APOPKA FL
32703
US

IV. Provider business mailing address

425 S HUNT CLUB BLVD STE 1051
APOPKA FL
32703
US

V. Phone/Fax

Practice location:
  • Phone: 407-786-4080
  • Fax: 407-786-4667
Mailing address:
  • Phone: 407-786-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS CHABAN
Title or Position: OWNER
Credential: MD
Phone: 407-786-4080