MEDICARE: WEST FLORIDA 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
1	208000000X	Pediatrics Physician	ME90418	FL

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	:	1992067342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST FLORIDA PEDIATRICS

Provider Business Mailing Address
First Line	:	3733 E GULF TO LAKE HWY
Second Line	:	SUITE B
City	:	INVERNESS
State	:	FL
Zip	:	34453-3206
Country	:	US
Telephone Number	:	352-746-3338
Fax Number	:	352-344-3414

Provider Business Practice Location Address
First Line	:	3733 E GULF TO LAKE HWY
Second Line	:	SUITE B
City	:	INVERNESS
State	:	FL
Zip	:	34453-3206
Country	:	US
Telephone Number	:	352-746-3338
Fax Number	:	352-344-3414

Authorized Official
Title or Position	:	OWNER
Name	:	DR. UDAY HIREMATH
Credential	:
Telephone Number	:	352-746-3338

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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Directions to “WEST FLORIDA PEDIATRICS ” Practice Location

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