MEDICARE: KIDZ MEDICAL SERVICES

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	2080P0204X	Pediatric Emergency Medicine (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	:	1700351863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDZ MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	5955 PONCE DE LEON BLVD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33146-2423
Country	:	US
Telephone Number	:	305-661-1515
Fax Number	:	305-662-3723

Provider Business Practice Location Address
First Line	:	9200 BONITA BEACH RD SE STE 106
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-4254
Country	:	US
Telephone Number	:	239-213-0690
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	IRENE NAVARRO
Credential	:
Telephone Number	:	305-663-2906

Provider Enumeration Date	:	10/04/2018
Last Update Date	:	07/10/2023

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Directions to “KIDZ MEDICAL SERVICES ” Practice Location

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