Healthcare Provider Details

I. General information

NPI: 1417813627
Provider Name (Legal Business Name): FLORIDA PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 MCMULLEN BOOTH RD
SAFETY HARBOR FL
34695-6607
US

IV. Provider business mailing address

1800 DR M.L.K. JR ST N
ST. PETERSBURG FL
33704
US

V. Phone/Fax

Practice location:
  • Phone: 813-503-8042
  • Fax:
Mailing address:
  • Phone:
  • 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: DR. BIPAN KOTWAL
Title or Position: MD
Credential: MD
Phone: 813-503-8042