Healthcare Provider Details

I. General information

NPI: 1023039351
Provider Name (Legal Business Name): PEDIATRIC SURGERY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SLIGH BLVD
ORLANDO FL
32806-1108
US

IV. Provider business mailing address

1220 SLIGH BLVD
ORLANDO FL
32806-1108
US

V. Phone/Fax

Practice location:
  • Phone: 407-228-4774
  • Fax: 407-228-2128
Mailing address:
  • Phone: 407-228-4774
  • Fax: 407-228-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK S CHAET
Title or Position: PRESIDENT
Credential: MD
Phone: 407-228-4774