Provider Demographics
NPI:1740527142
Name:ORLANDO PEDIATRICS
Entity type:Organization
Organization Name:ORLANDO PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMIER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAZNADAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-483-7925
Mailing Address - Street 1:PO BOX 770458
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32877-0458
Mailing Address - Country:US
Mailing Address - Phone:407-361-5123
Mailing Address - Fax:
Practice Address - Street 1:800 N ROSE AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4944
Practice Address - Country:US
Practice Address - Phone:407-483-7925
Practice Address - Fax:407-483-7924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263337000Medicaid