Healthcare Provider Details

I. General information

NPI: 1508815655
Provider Name (Legal Business Name): PHOENIX PEDIATRICS OF BROWARD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CORAL HILLS DR PHOENIX PEDIATRICS OF BROWARD
CORAL SPRINGS FL
33065-4108
US

IV. Provider business mailing address

PO BOX 80328
PHILADELPHIA PA
19101-1328
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-5000
  • Fax: 877-250-6889
Mailing address:
  • Phone:
  • 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: CHRISTOPHER KENNEDY
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 207-807-9009