Healthcare Provider Details

I. General information

NPI: 1730215112
Provider Name (Legal Business Name): KIDSTOWN PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 NE 89TH ST
EL PORTAL FL
33138-3119
US

IV. Provider business mailing address

7800 SW 87TH AVE
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-5437
  • Fax: 305-576-5120
Mailing address:
  • Phone: 954-731-9676
  • Fax: 954-731-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARGARET OKONKWO
Title or Position: MD
Credential: MD
Phone: 305-576-5437