Provider Demographics
NPI:1619368750
Name:BC PEDIATRICS INC
Entity Type:Organization
Organization Name:BC PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLABISI
Authorized Official - Middle Name:
Authorized Official - Last Name:OYADIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-625-4100
Mailing Address - Street 1:99 NW 183RD ST
Mailing Address - Street 2:STE 114
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4502
Mailing Address - Country:US
Mailing Address - Phone:305-625-4100
Mailing Address - Fax:305-625-4004
Practice Address - Street 1:99 NW 183RD ST
Practice Address - Street 2:STE 114
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4502
Practice Address - Country:US
Practice Address - Phone:305-625-4100
Practice Address - Fax:305-625-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251580600Medicaid