Healthcare Provider Details

I. General information

NPI: 1992402341
Provider Name (Legal Business Name): CONCIERGE PEDIATRICS FL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 41ST STREET UNIT 406
MIAMI BEACH FL
33140-3314
US

IV. Provider business mailing address

2115 CENTRAL AVE
ST PETERSBURG FL
33713-8815
US

V. Phone/Fax

Practice location:
  • Phone: 305-239-3119
  • Fax:
Mailing address:
  • Phone: 727-688-8515
  • 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: MICHAEL CIBRAN
Title or Position: PARTNER
Credential:
Phone: 727-688-8515