Provider Demographics
NPI:1114298601
Name:KIDSWOODS PEDIATRICS CORP
Entity Type:Organization
Organization Name:KIDSWOODS PEDIATRICS CORP
Other - Org Name:ZULLY E AMBROISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZULLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:AMBROISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-398-6470
Mailing Address - Street 1:1177 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1936 LEE RD
Practice Address - Street 2:SUTIE 137
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7229
Practice Address - Country:US
Practice Address - Phone:321-207-0623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98395208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278141700Medicaid