MEDICARE: THE KIDS DOCTOR, INC

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

General Provider Information

NPI Number	:	1629873104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KIDS DOCTOR, INC

Provider Business Mailing Address
First Line	:	10549 N FLORIDA AVE STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6707
Country	:	US
Telephone Number	:	813-978-1522
Fax Number	:	813-971-3330

Provider Business Practice Location Address
First Line	:	10549 N FLORIDA AVE STE B
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-6707
Country	:	US
Telephone Number	:	813-978-1522
Fax Number	:	813-971-3330

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHELLE MCDONALD
Credential	:	OWNER
Telephone Number	:	813-971-3844

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/18/2025

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Directions to “THE KIDS DOCTOR, INC ” Practice Location

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