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General NPI Number Information
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NPI Number | 1952012429
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Entity Type | Organization
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Legal Business Name | PEDIATRIC MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 836 PAUL ST
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City | ORLANDO
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State | FL
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Zip | 32808-7545
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Country | US
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Telephone | 407-295-2039
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Fax |
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Provider Business Mailing Address
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Address Line | 836 PAUL ST
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City | ORLANDO
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State | FL
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Zip | 32808-7545
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Country | US
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Telephone | 407-295-2039
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. IJAZ AHMED
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Credential |
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Telephone | 407-342-1896
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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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