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General NPI Number Information
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NPI Number | 1891423976
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Entity Type | Organization
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Legal Business Name | COOL KIDZ PEDIATRICS LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 301 N PARSONS AVE STE A
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City | BRANDON
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State | FL
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Zip | 33510-4517
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Country | US
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Telephone | 813-655-5807
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Fax |
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Provider Business Mailing Address
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Address Line | 208 W DR MARTIN LUTHER KING JR BLVD
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City | TAMPA
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State | FL
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Zip | 33603-3602
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Country | US
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Telephone | 813-873-1725
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | KESHAVA BABU
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Credential | MD
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Telephone | 813-655-5807
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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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