Provider Demographics
NPI:1508226879
Name:MAMIPEDIATRICS LLC
Entity Type:Organization
Organization Name:MAMIPEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SULTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-363-6312
Mailing Address - Street 1:21659 MARIGOT DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4825
Mailing Address - Country:US
Mailing Address - Phone:602-363-6312
Mailing Address - Fax:
Practice Address - Street 1:2020 NE 163RD ST STE 105
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4927
Practice Address - Country:US
Practice Address - Phone:305-790-9058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 126460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty