Provider Demographics
NPI:1912397837
Name:PEDIATRIC CARE OF KENDALL LLC
Entity Type:Organization
Organization Name:PEDIATRIC CARE OF KENDALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:CONRAD
Authorized Official - Last Name:FRANKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-271-4904
Mailing Address - Street 1:8525 SW 92ND ST
Mailing Address - Street 2:D-14
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7365
Mailing Address - Country:US
Mailing Address - Phone:305-271-4904
Mailing Address - Fax:305-271-9856
Practice Address - Street 1:8525 SW 92ND ST
Practice Address - Street 2:D-14
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7365
Practice Address - Country:US
Practice Address - Phone:305-271-4904
Practice Address - Fax:305-271-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15877261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care