=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003189432
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S MEDICAL CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2012
-----------------------------------------------------
Last Update Date | 02/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 NW 183RD ST STE 133
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-4531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-651-9979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 NW 183RD ST STE 133
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-4531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-651-9979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ZAFAR I QURESHI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-651-9979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME0073654
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------