Organization
TOTAL PEDIATRIC HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEWART AUBREY GRANT M.D. (OWNER)
(813) 655-5106
Entity
Organization
Contact information
Practice address
203 KINGSWAY RD, STE A, BRANDON, FL 33510-4679
(813) 655-5106
Mailing address
16765 FISHHAWK BLVD # 314, LITHIA, FL 33547-3860
(813) 655-5106
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME72163
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252632800
—
FL
Enumeration date
12/08/2011
Last updated
12/12/2011
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