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General NPI Number Information
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NPI Number | 1598087611
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Entity Type | Organization
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Legal Business Name | KIDS-MEDICAL
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 882 S KIRKMAN RD SUITE 105
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City | ORLANDO
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State | FL
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Zip | 32811-2652
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Country | US
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Telephone | 407-722-1652
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Fax | 407-286-0656
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Provider Business Mailing Address
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Address Line | PO BOX 770485
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City | ORLANDO
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State | FL
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Zip | 32877-0485
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Country | US
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Telephone | 407-722-1652
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Fax | 407-286-0656
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Authorized Official
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Title or Position | OWNER
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Name | DAVID A AFANADOR
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Credential | PRESIDENT
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Telephone | 407-722-1652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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