National Provider Identifier Database

PEDIATRIC ENT LLC
Pediatric Otolaryngology

A pediatric otolaryngologist has special expertise in the management of infants and children with disorders that include congenital and acquired conditions involving the aerodigestive tract, nose and paranasal sinuses, the ear and other areas of the head and neck. The pediatric otolaryngologist has special skills in the diagnosis, treatment, and management of childhood disorders of voice, speech, language and hearing.


Contact Information

PEDIATRIC ENT, LLC
1499 S HARBOR CITY BLVD STE 303
MELBOURNE, FL32901-3245
Phone: 321-254-5437
Fax: 321-254-4543
Website:
Specialty Taxonomy Code
* Pediatric Otolaryngology 207YP0228X

* Indicates primary specialty

NPI Profile & details for PEDIATRIC ENT, LLC

NPI Number 1508002072
Legal business name
LBN
PEDIATRIC ENT, LLC
Authorized official DAVID MALIS - (MANAGER)
Entity Organization
Organization subpart No
Enumeration date 01/05/2009
Last updated 04/18/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • FL License #: ME90348
  • FL Medicaid: 271247400
  • FL Other: 01269821 MEDICAID HMO - AMERIGROUP
  • FL Other: 2258392 MEDICAID HMO - UNITED HEALTH CARE
  • FL Other: 332181 MEDICAID HMO - WELLCARE

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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