Healthcare Provider Details

I. General information

NPI: 1902069826
Provider Name (Legal Business Name): BVL PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 BOGGY CREEK RD
KISSIMMEE FL
34744-3806
US

IV. Provider business mailing address

2535 BOGGY CREEK RD
KISSIMMEE FL
34744-3806
US

V. Phone/Fax

Practice location:
  • Phone: 407-344-0021
  • Fax: 407-344-0043
Mailing address:
  • Phone: 407-344-0021
  • Fax: 407-344-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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