MEDICARE: PEDIATRIC & PERINATAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NP0017X	Pediatric Chiropractor
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043980568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC & PERINATAL CORP

Provider Business Mailing Address
First Line	:	12731 WORLD PLAZA LN BLDG 83-1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4081
Country	:	US
Telephone Number	:	239-887-3283
Fax Number	:

Provider Business Practice Location Address
First Line	:	12731 WORLD PLAZA LN BLDG 83-1
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4081
Country	:	US
Telephone Number	:	239-839-0337
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIENNE GINDELE
Credential	:	DC
Telephone Number	:	239-839-0337

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/16/2021

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Directions to “PEDIATRIC & PERINATAL CORP ” Practice Location

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