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NPI Code Detail

MEDICARE: PEDIATRIC PROFESSIONAL ASSOCIATES, P.A.

MEDICARE: PEDIATRIC PROFESSIONAL ASSOCIATES, P.A.
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
1208000000XPediatrics Physician0319624FL

General Provider Information

NPI Number : 1417950684
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC PROFESSIONAL ASSOCIATES, P.A.
Provider Business Mailing Address
First Line : 7001 SW 87TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33173-2505
Country : US
Telephone Number : 305-271-8222
Fax Number : 305-274-6316
Provider Business Practice Location Address
First Line : 7001 SW 87TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33173-2505
Country : US
Telephone Number : 305-271-8222
Fax Number : 305-274-6316
Authorized Official
Title or Position : PRESIDENT
Name : HARVEY SIMOVITCH
Credential : MD
Telephone Number : 305-271-8222
Provider Enumeration Date : 05/23/2005
Last Update Date : 08/22/2020

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