Provider Demographics
NPI:1699954255
Name:KIDZ FIRST PEDIATRICS OF OBERLIN, LLC
Entity type:Organization
Organization Name:KIDZ FIRST PEDIATRICS OF OBERLIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-775-1555
Mailing Address - Street 1:12289 LEAVITT RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-8500
Mailing Address - Country:US
Mailing Address - Phone:440-775-1555
Mailing Address - Fax:
Practice Address - Street 1:12289 LEAVITT RD
Practice Address - Street 2:UNIT D
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-8500
Practice Address - Country:US
Practice Address - Phone:440-775-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457449035OtherINDIVIDUAL NPI