is a Pediatric Critical Care Medicine in , . practices all healthcare services and medical treatments related to Pediatric Critical Care Medicine. The NPI Number for is 1265484885. The last update date is .
's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!
Provider Profile Detail
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| Address | , , |
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| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1265484885 |
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| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | |
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| State | () |
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Provider's Primary Taxonomy Detail
| Speciality | Pediatric Critical Care Medicine |
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| Taxonomy | 2080P0203X |
| Licence No | 22653 |
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Definition: A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surg |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 3166 | NE | BCBS | |
| 241353 | MIDLANDS CHOICE | ||
| 572321 | IA | -- |
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