=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891737516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDS AND TEENS ORTHOPAEDIC SURGERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 12/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8645 N MILITARY TRL SUITE 501
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33410-6294
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-691-8050
-----------------------------------------------------
Fax | 561-622-9942
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 32367
-----------------------------------------------------
City | PALM BEACH GARDENS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33420-2367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-906-7680
-----------------------------------------------------
Fax | 866-405-2914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. AHAMED MOHAIDEEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 561-906-7680
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME 84411
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------