Organization
ADVANCED PEDIATRIC PULMONOLOGY, PLLC
Active
Other names
n/a
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIE MYRTHA GREGOIRE-BOTTEX MD (MANAGING MEMBER)
(914) 462-7411
Entity
Organization
Contact information
Practice address
1971 SW 172ND AVE STE 3128, MIRAMAR, FL 33029-5592
(954) 299-5272
(855) 583-3365
Mailing address
2701 BISCAYNE BLVD APT 7102, MIAMI, FL 33137-5302
(914) 462-7411
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00118945800
—
FL
05
—
102074500
—
FL
01
—
10D2296465
CLIA
FL
01
—
11995072
CAQH
—
01
—
1J6FX
FLORIDA BLUE
FL
01
—
2HXM4
FLORIDA BLUE PROVIDER
FL
Enumeration date
06/09/2023
Last updated
08/05/2024
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