MEDICARE: KIDSFIRST PEDIATRICS COMPANY

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	174400000X	Specialist

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	:	1104838796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDSFIRST PEDIATRICS COMPANY

Provider Business Mailing Address
First Line	:	35010 CHARDON RD
Second Line	:	SUITE 205
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-9010
Country	:	US
Telephone Number	:	440-918-0501
Fax Number	:	440-918-0525

Provider Business Practice Location Address
First Line	:	35010 CHARDON RD
Second Line	:	SUITE 205
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-9010
Country	:	US
Telephone Number	:	440-918-0501
Fax Number	:	440-918-0525

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MICHELLE OTTO
Credential	:
Telephone Number	:	440-918-0501

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	05/02/2013

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Directions to “KIDSFIRST PEDIATRICS COMPANY ” Practice Location

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