Provider Demographics
NPI:1710147533
Name:SAGE PEDIATRICS PA
Entity Type:Organization
Organization Name:SAGE PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAKUNLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLAGBEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-949-1275
Mailing Address - Street 1:1990 NE 163RD STREET
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4854
Mailing Address - Country:US
Mailing Address - Phone:305-949-1275
Mailing Address - Fax:305-949-1273
Practice Address - Street 1:1990 NE 163RD ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4854
Practice Address - Country:US
Practice Address - Phone:305-949-1275
Practice Address - Fax:305-949-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 71575261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care