Organization
PM PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELE JOHNSON M.D. (OWNER/MD)
(813) 264-2288
Entity
Organization
Contact information
Practice address
1338 W FLETCHER AVE, TAMPA, FL 33612-3366
(813) 264-2288
(813) 264-1677
Mailing address
1338 W FLETCHER AVE, TAMPA, FL 33612-3366
(813) 264-2288
(813) 264-1677
Taxonomy
Speciality
Code
Description
License number
State
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
ME62751
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015478400
—
FL
Enumeration date
10/31/2013
Last updated
10/29/2015
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