Provider Demographics
NPI:1497138952
Name:ABC KID'S PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ABC KID'S PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-802-2089
Mailing Address - Street 1:333 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE 514
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3641
Mailing Address - Country:US
Mailing Address - Phone:786-802-2089
Mailing Address - Fax:786-802-2091
Practice Address - Street 1:333 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE 514
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33140-3641
Practice Address - Country:US
Practice Address - Phone:786-802-2089
Practice Address - Fax:786-802-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94530261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277451800Medicaid