Provider Demographics
NPI:1447505961
Name:KID MD PEDIATRICS LLC
Entity type:Organization
Organization Name:KID MD PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-FLORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-347-6144
Mailing Address - Street 1:13848 TILDEN RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5326
Mailing Address - Country:US
Mailing Address - Phone:407-347-6144
Mailing Address - Fax:
Practice Address - Street 1:13848 TILDEN RD
Practice Address - Street 2:SUITE 230
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5326
Practice Address - Country:US
Practice Address - Phone:407-347-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty