Healthcare Provider Details

I. General information

NPI: 1740242593
Provider Name (Legal Business Name): PEDIATRIC CARE GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7848 LAKE UNDERHILL RD
ORLANDO FL
32822-8227
US

IV. Provider business mailing address

7848 LAKE UNDERHILL RD
ORLANDO FL
32822-8227
US

V. Phone/Fax

Practice location:
  • Phone: 407-275-2676
  • Fax: 407-275-2681
Mailing address:
  • Phone: 407-275-2676
  • Fax: 407-275-2681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MIGUEL SILVA
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 407-275-2676