Healthcare Provider Details

I. General information

NPI: 1386239663
Provider Name (Legal Business Name): KIDZMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 VINELAND RD STE 111
ORLANDO FL
32819-7855
US

IV. Provider business mailing address

7234 STILL POND LN
WINDERMERE FL
34786-0147
US

V. Phone/Fax

Practice location:
  • Phone: 407-492-2338
  • Fax:
Mailing address:
  • Phone: 407-492-2338
  • 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: CHRISTINE CHAN-RAGAZZO
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 407-492-2338