Provider Demographics
NPI:1891737516
Name:KIDS AND TEENS ORTHOPAEDIC SURGERY
Entity Type:Organization
Organization Name:KIDS AND TEENS ORTHOPAEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAIDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-906-7680
Mailing Address - Street 1:PO BOX 32367
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33420-2367
Mailing Address - Country:US
Mailing Address - Phone:561-906-7680
Mailing Address - Fax:866-405-2914
Practice Address - Street 1:8645 N MILITARY TRL
Practice Address - Street 2:SUITE 501
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6294
Practice Address - Country:US
Practice Address - Phone:561-691-8050
Practice Address - Fax:561-622-9942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84411207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264003100Medicaid
FL13323YMedicare PIN
FL264003100Medicaid
FLAB072Medicare PIN