Provider Demographics
NPI:1194861211
Name:DK PEDIATRICS
Entity Type:Organization
Organization Name:DK PEDIATRICS
Other - Org Name:NEW TAMPA PEDIATRICS & ADOLESCENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-973-2500
Mailing Address - Street 1:2230 ASHLEY OAKS CIR
Mailing Address - Street 2:STE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6429
Mailing Address - Country:US
Mailing Address - Phone:813-973-2500
Mailing Address - Fax:813-973-4438
Practice Address - Street 1:2230 ASHLEY OAKS CIR
Practice Address - Street 2:STE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6429
Practice Address - Country:US
Practice Address - Phone:813-973-2500
Practice Address - Fax:813-973-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275477100Medicaid