Provider Demographics
NPI:1336198993
Name:KIDD PEDIATRICS
Entity Type:Organization
Organization Name:KIDD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIDD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-882-0136
Mailing Address - Street 1:373 MERIDIAN PARKE LN
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-9419
Mailing Address - Country:US
Mailing Address - Phone:317-882-0136
Mailing Address - Fax:317-882-3123
Practice Address - Street 1:373 MERIDIAN PARKE LN
Practice Address - Street 2:SUITE C-1
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-9419
Practice Address - Country:US
Practice Address - Phone:317-882-0136
Practice Address - Fax:317-882-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200325060AMedicaid
IN200325060AMedicaid