MEDICARE: PHOENIX PEDIATRICS OF BROWARD LLC

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	208000000X	Pediatrics Physician

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	:	1508815655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX PEDIATRICS OF BROWARD LLC

Provider Business Mailing Address
First Line	:	PO BOX 781065
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-1065
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:	877-250-6889

Provider Business Practice Location Address
First Line	:	3000 CORAL HILLS DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4108
Country	:	US
Telephone Number	:	954-939-5000
Fax Number	:	877-250-6889

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	CHRISTOPHER KENNEDY
Credential	:
Telephone Number	:	207-807-9009

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	06/02/2026

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