MEDICARE: CONTEMPORARY PEDIATRICS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	34003507M	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609042647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTEMPORARY PEDIATRICS, INC.

Provider Business Mailing Address
First Line	:	1516 YANKEE PARK PL
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1878
Country	:	US
Telephone Number	:	937-438-1115
Fax Number	:	937-424-4721

Provider Business Practice Location Address
First Line	:	1516 YANKEE PARK PL
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-1878
Country	:	US
Telephone Number	:	937-438-1115
Fax Number	:	937-424-4721

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT PAUL MYERS
Credential	:	D.O.
Telephone Number	:	937-438-1115

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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