Provider Demographics
NPI:1902294382
Name:PEDIATRIC PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKBAR
Authorized Official - Middle Name:
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-344-0021
Mailing Address - Street 1:1207 E VINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3545
Mailing Address - Country:US
Mailing Address - Phone:407-344-0021
Mailing Address - Fax:407-286-4167
Practice Address - Street 1:1207 E VINE ST STE A
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3545
Practice Address - Country:US
Practice Address - Phone:407-344-0021
Practice Address - Fax:407-286-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69091208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty