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General NPI Number Information
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NPI Number | 1629873104
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Entity Type | Organization
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Legal Business Name | THE KIDS DOCTOR, INC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 10549 N FLORIDA AVE STE B
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City | TAMPA
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State | FL
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Zip | 33612-6707
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Country | US
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Telephone | 813-978-1522
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Fax | 813-971-3330
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Provider Business Mailing Address
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Address Line | 10549 N FLORIDA AVE STE B
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City | TAMPA
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State | FL
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Zip | 33612-6707
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Country | US
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Telephone | 813-978-1522
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Fax | 813-971-3330
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHELLE MCDONALD
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Credential | OWNER
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Telephone | 813-971-3844
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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 |
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License Number State |
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