=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649660895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDS AND MORE PEDIATRIC CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2015
-----------------------------------------------------
Last Update Date | 01/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 302 BRYAN RD SUITE 1
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-5337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-654-1220
-----------------------------------------------------
Fax | 813-654-6746
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 302 BRYAN RD SUITE 1
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-5337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-654-1220
-----------------------------------------------------
Fax | 813-654-6746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT MICHAEL FRIEDMEYER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-654-1220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number | ME60516
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------