Provider Demographics
NPI:1003356536
Name:KID FRIENDLY PEDIATRICS PA
Entity Type:Organization
Organization Name:KID FRIENDLY PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EWA
Authorized Official - Middle Name:K
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-762-7109
Mailing Address - Street 1:2376 LAVON DR STE 130
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-9001
Mailing Address - Country:US
Mailing Address - Phone:972-496-6633
Mailing Address - Fax:
Practice Address - Street 1:2376 LAVON DR STE 130
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-9001
Practice Address - Country:US
Practice Address - Phone:972-496-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9430208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX369997701Medicaid