Provider Demographics
NPI:1992402341
Name:CONCIERGE PEDIATRICS FL LLC
Entity type:Organization
Organization Name:CONCIERGE PEDIATRICS FL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CIBRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-688-8515
Mailing Address - Street 1:2115 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8815
Mailing Address - Country:US
Mailing Address - Phone:727-688-8515
Mailing Address - Fax:
Practice Address - Street 1:410 W 41ST STREET
Practice Address - Street 2:UNIT 406
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3314
Practice Address - Country:US
Practice Address - Phone:305-239-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNONE