Provider Demographics
NPI:1518066307
Name:LIFE SPRING PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:LIFE SPRING PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADETOKUNBOH
Authorized Official - Middle Name:
Authorized Official - Last Name:AJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-473-2128
Mailing Address - Street 1:8320 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5435
Mailing Address - Country:US
Mailing Address - Phone:954-473-2128
Mailing Address - Fax:954-476-6836
Practice Address - Street 1:8320 W SUNRISE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5435
Practice Address - Country:US
Practice Address - Phone:954-473-2128
Practice Address - Fax:954-476-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76784208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty