Healthcare Provider Details

I. General information

NPI: 1700055407
Provider Name (Legal Business Name): PEDIATRICS ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 45TH ST SUITE 200
WEST PALM BEACH FL
33407-2016
US

IV. Provider business mailing address

2100 45TH ST SUITE 200
WEST PALM BEACH FL
33407-2016
US

V. Phone/Fax

Practice location:
  • Phone: 561-840-1500
  • Fax: 561-840-1505
Mailing address:
  • Phone: 561-840-1500
  • Fax: 561-840-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90852
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN TAKAS
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 561-840-1500