Provider Demographics
NPI:1407355472
Name:MY KIDS PEDIATRIC PARTNERS PC
Entity Type:Organization
Organization Name:MY KIDS PEDIATRIC PARTNERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:KUNEC
Authorized Official - Last Name:SUDO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-235-1470
Mailing Address - Street 1:1102 HIGHWAY 315 BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6943
Mailing Address - Country:US
Mailing Address - Phone:570-235-1470
Mailing Address - Fax:570-550-9256
Practice Address - Street 1:1102 HIGHWAY 315 BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6943
Practice Address - Country:US
Practice Address - Phone:570-235-1470
Practice Address - Fax:570-550-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009616-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty