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NPI Code Detail

MEDICARE: PRO STAR PEDIATRICS

MEDICARE: PRO STAR PEDIATRICS
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
12080A0000XPediatric Adolescent Medicine PhysicianME0036554FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972679223
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRO STAR PEDIATRICS
Provider Business Mailing Address
First Line : 8701 MAITLAND SUMMIT BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32810-5915
Country : US
Telephone Number : 407-916-4522
Fax Number : 407-916-4525
Provider Business Practice Location Address
First Line : 8701 MAITLAND SUMMIT BLVD
Second Line :
City : ORLANDO
State : FL
Zip : 32810-5915
Country : US
Telephone Number : 407-916-4522
Fax Number : 407-916-4525
Authorized Official
Title or Position : VICE PRESIDENT
Name : ALBERTO COBIAN
Credential :
Telephone Number : 407-916-4522
Provider Enumeration Date : 11/28/2006
Last Update Date : 02/20/2014

Similar Medicare Providers

1447258249 — DR. MARK A. BECKNER M.D.
Practice Location Address:
8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
32810-5915
Practice Phone: 407-916-4120
Practice Fax: 407-643-2806
1457350191 — DR. CRAIG M. MINTZER M.D.
Practice Location Address:
8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
32810-5915
Practice Phone: 407-916-4120
Practice Fax: 407-643-2806
1396768826 — DR. BARRY FRANKLIN PORTNOY M.D.
Practice Location Address:
8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
32810-5915
Practice Phone: 407-916-4551
Practice Fax: 407-916-4552
1578639894 — LARITSSA PALACIO COBIAN MD
Practice Location Address:
8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
32810-5915
Practice Phone: 407-916-4522
Practice Fax: 407-916-4525
1346316601 — LYNN MERRITT BERRINGER MD
Practice Location Address:
8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
32810-5915
Practice Phone: 407-916-4522
Practice Fax: 407-916-4525
1902972284 — KATHERINE NICHOLE VELEZ MD
Practice Location Address:
8701 MAITLAND SUMMIT BLVD
ORLANDO, FL
32810-5915
Practice Phone: 407-916-4522
Practice Fax: 407-916-4525

Directions to “PRO STAR PEDIATRICS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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