MEDICARE: PEDIATRICS ALLIANCE, 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	ME90852	FL

General Provider Information

NPI Number	:	1700055407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICS ALLIANCE, LLC

Provider Business Mailing Address
First Line	:	2100 45TH ST
Second Line	:	SUITE 200
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2016
Country	:	US
Telephone Number	:	561-840-1500
Fax Number	:	561-840-1505

Provider Business Practice Location Address
First Line	:	2100 45TH ST
Second Line	:	SUITE 200
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2016
Country	:	US
Telephone Number	:	561-840-1500
Fax Number	:	561-840-1505

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. STEVEN TAKAS
Credential	:	M.D.
Telephone Number	:	561-840-1500

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	02/27/2008

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