Provider Demographics
NPI:1598087611
Name:KIDS-MEDICAL
Entity Type:Organization
Organization Name:KIDS-MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:AFANADOR
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:407-722-1652
Mailing Address - Street 1:PO BOX 770485
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32877-0485
Mailing Address - Country:US
Mailing Address - Phone:407-722-1652
Mailing Address - Fax:407-286-0656
Practice Address - Street 1:882 S KIRKMAN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2652
Practice Address - Country:US
Practice Address - Phone:407-722-1652
Practice Address - Fax:407-286-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care