Provider Demographics
NPI:1710468848
Name:COOL KIDZ PEDIATRICS LLC
Entity Type:Organization
Organization Name:COOL KIDZ PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHAVA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BABU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-223-3300
Mailing Address - Street 1:208 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2123 W DR MARTIN LUTHER KING JR BLVD STE 201
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6545
Practice Address - Country:US
Practice Address - Phone:813-873-1725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOL KIDZ PEDIATRICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-27
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067708600Medicaid