Healthcare Provider Details

I. General information

NPI: 1902294382
Provider Name (Legal Business Name): PEDIATRIC PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 01/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 E VINE ST STE A
KISSIMMEE FL
34744-3545
US

IV. Provider business mailing address

1207 E VINE ST STE A
KISSIMMEE FL
34744-3545
US

V. Phone/Fax

Practice location:
  • Phone: 407-344-0021
  • Fax: 407-286-4167
Mailing address:
  • Phone: 407-344-0021
  • Fax: 407-286-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME69091
License Number StateFL

VIII. Authorized Official

Name: DR. AKBAR QURESHI
Title or Position: OWNER
Credential: MD
Phone: 407-344-0021