Provider Demographics
NPI:1437292521
Name:PEDIATRIC INFECTIOUS DISEASES LLC
Entity Type:Organization
Organization Name:PEDIATRIC INFECTIOUS DISEASES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-662-8378
Mailing Address - Street 1:3200 SW 60TH CT
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4000
Mailing Address - Country:US
Mailing Address - Phone:305-662-8378
Mailing Address - Fax:
Practice Address - Street 1:3200 SW 60TH CT
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4000
Practice Address - Country:US
Practice Address - Phone:305-662-8378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME349912080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty