Provider Demographics
NPI:1336594316
Name:PEDIATRIC CARDIOLOGY SPECIALISTS PL
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY SPECIALISTS PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABU
Authorized Official - Suffix:
Authorized Official - Credentials:
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:813-223-3300
Mailing Address - Fax:
Practice Address - Street 1:208 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3602
Practice Address - Country:US
Practice Address - Phone:813-223-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253439801Medicaid