Organization
ADVANCED KID'S CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BERNADETTE ANTONYRAJAH MD (DIRECTOR)
(419) 819-7137
Entity
Organization
Contact information
Practice address
98 TERRA MANGO LOOP, UNIT 12, ORLANDO, FL 32835
(419) 819-7137
Mailing address
5049 LATROBE DR, WINDERMERE, FL 34786-8914
(419) 819-6804
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME113681
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3108461
—
FL
Enumeration date
12/05/2017
Last updated
12/05/2017
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