Provider Demographics
NPI:1649660895
Name:KIDS AND MORE PEDIATRIC CARE
Entity type:Organization
Organization Name:KIDS AND MORE PEDIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FRIEDMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-654-1220
Mailing Address - Street 1:302 BRYAN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5337
Mailing Address - Country:US
Mailing Address - Phone:813-654-1220
Mailing Address - Fax:813-654-6746
Practice Address - Street 1:302 BRYAN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5337
Practice Address - Country:US
Practice Address - Phone:813-654-1220
Practice Address - Fax:813-654-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME605162080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL60516OtherLICENSE
FL280296100Medicaid
E24174OtherUPIN