Provider Demographics
NPI:1245392943
Name:ACD PEDIATRIC GROUP
Entity Type:Organization
Organization Name:ACD PEDIATRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:ANEIDA
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-826-9449
Mailing Address - Street 1:3416 W 84TH STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4933
Mailing Address - Country:US
Mailing Address - Phone:305-826-9449
Mailing Address - Fax:305-828-1255
Practice Address - Street 1:3416 W 84TH STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4933
Practice Address - Country:US
Practice Address - Phone:305-826-9449
Practice Address - Fax:305-828-1255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACD PEDIATRIC GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-16
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity MedicineGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255288400Medicaid
FL255288400Medicaid