Provider Demographics
NPI:1063568855
Name:HUNTCLUB PEDIATRIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:HUNTCLUB PEDIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-786-4080
Mailing Address - Street 1:425 S HUNT CLUB BLVD
Mailing Address - Street 2:STE 1051
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703
Mailing Address - Country:US
Mailing Address - Phone:407-786-4080
Mailing Address - Fax:
Practice Address - Street 1:425 S HUNT CLUB BLVD
Practice Address - Street 2:STE 1051
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703
Practice Address - Country:US
Practice Address - Phone:407-786-4080
Practice Address - Fax:407-786-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID