Healthcare Provider Details

I. General information

NPI: 1932441144
Provider Name (Legal Business Name): MT CARMEL PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KNUTH RD SUITE 106
BOYNTON BEACH FL
33436-4629
US

IV. Provider business mailing address

200 KNUTH RD SUITE 106
BOYNTON BEACH FL
33436-4629
US

V. Phone/Fax

Practice location:
  • Phone: 561-600-9015
  • Fax: 561-600-9016
Mailing address:
  • Phone: 561-600-9015
  • Fax: 561-600-9016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0041663
License Number StateFL

VIII. Authorized Official

Name: DR. JEANNE GO
Title or Position: MGRM
Credential: M.D.
Phone: 561-600-9015