Provider Demographics
NPI:1366659146
Name:CDRS PEDIATRICS MDS PA
Entity Type:Organization
Organization Name:CDRS PEDIATRICS MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DOURED
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGHISTANI
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:305-274-1662
Mailing Address - Street 1:8940 N KENDALL DR
Mailing Address - Street 2:SUITE 603E
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2148
Mailing Address - Country:US
Mailing Address - Phone:305-274-1662
Mailing Address - Fax:
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:SUITE 603E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2148
Practice Address - Country:US
Practice Address - Phone:305-274-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME547582080P0203X
FLME751802080P0203X
FLME471642080P0207X
FLME565162080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty
Not Answered2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
Not Answered2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Multi-Specialty