Provider Demographics
NPI:1902069826
Name:BVL PEDIATRICS LLC
Entity type:Organization
Organization Name:BVL PEDIATRICS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKBAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-344-0021
Mailing Address - Street 1:2535 BOGGY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-3806
Mailing Address - Country:US
Mailing Address - Phone:407-344-0021
Mailing Address - Fax:407-344-0043
Practice Address - Street 1:2535 BOGGY CREEK RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3806
Practice Address - Country:US
Practice Address - Phone:407-344-0021
Practice Address - Fax:407-344-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3791513002Medicaid
FLG38336Medicare UPIN