Healthcare Provider Details

I. General information

NPI: 1326503301
Provider Name (Legal Business Name): ADVANCED PEDIATRIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11331 CORTEZ BLVD
BROOKSVILLE FL
34613-5404
US

IV. Provider business mailing address

11331 CORTEZ BLVD
BROOKSVILLE FL
34613-5404
US

V. Phone/Fax

Practice location:
  • Phone: 352-247-2533
  • Fax: 352-247-2535
Mailing address:
  • Phone: 352-247-2533
  • Fax: 352-247-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD K SAMI
Title or Position: OWNER / PROVIDER
Credential: MD
Phone: 352-247-2533