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General NPI Number Information
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NPI Number | 1104055466
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Entity Type | Organization
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Legal Business Name | CHILDREN'S ORTHOPAEDIC & SCOLIOSIS SURGERY ASSOCIATES, LLP
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 3440 W DR MARTIN LUTHER KING JR BLVD STE 200
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City | TAMPA
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State | FL
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Zip | 33607-6223
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Country | US
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Telephone | 813-879-2663
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Fax | 813-872-0286
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Provider Business Mailing Address
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Address Line | 625 6TH AVE S STE 450
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4629
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Country | US
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Telephone | 727-898-2663
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Fax | 727-568-6836
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CAROL ITTIG
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Credential | MBA, FACMPE
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Telephone | 727-568-6840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number |
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License Number State |
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