Provider Demographics
NPI:1225339807
Name:CHILDREN'S LUNG AND SLEEP SPECIALISTS PA
Entity Type:Organization
Organization Name:CHILDREN'S LUNG AND SLEEP SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKINYEMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-383-0556
Mailing Address - Street 1:PO BOX 540326
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32854-0326
Mailing Address - Country:US
Mailing Address - Phone:866-383-0556
Mailing Address - Fax:877-898-9443
Practice Address - Street 1:5251 W CAMPBELL AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1715
Practice Address - Country:US
Practice Address - Phone:866-383-0556
Practice Address - Fax:877-898-9443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ432112080P0214X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1617458-7OtherCORPORATION REGISTRATION