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General NPI Number Information
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NPI Number | 1063613750
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Entity Type | Organization
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Legal Business Name | WORLD PEDIATRICS
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3470 WASHINGTON DR SUITE 201
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City | EAGAN
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State | MN
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Zip | 55122-1355
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Country | US
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Telephone | 651-454-7371
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Fax | 651-454-9076
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Provider Business Mailing Address
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Address Line | 3470 WASHINGTON DR SUITE 201
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City | EAGAN
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State | MN
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Zip | 55122-1355
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Country | US
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Telephone | 651-454-7371
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Fax | 651-454-9076
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALID MAALOULI
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Credential | M.D.
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Telephone | 651-454-7371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MN43201
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License Number State | MN
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