Provider Demographics
NPI:1821100967
Name:FLICKER PAUL GOLDBERG & KELLER, M.D., P.A.
Entity Type:Organization
Organization Name:FLICKER PAUL GOLDBERG & KELLER, M.D., P.A.
Other - Org Name:KINGS BAY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FLICKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-253-5586
Mailing Address - Street 1:8750 SW 144TH ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7296
Mailing Address - Country:US
Mailing Address - Phone:305-253-5585
Mailing Address - Fax:305-253-5679
Practice Address - Street 1:8750 SW 144TH ST
Practice Address - Street 2:SUITE #100
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7296
Practice Address - Country:US
Practice Address - Phone:305-253-5585
Practice Address - Fax:305-253-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty