=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417813627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORIDA PEDIATRIC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2025
-----------------------------------------------------
Last Update Date | 12/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3231 MCMULLEN BOOTH RD
-----------------------------------------------------
City | SAFETY HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34695-6607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-503-8042
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 DR M.L.K. JR ST N
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | DR. BIPAN KOTWAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-503-8042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------