Healthcare Provider Details

I. General information

NPI: 1568633253
Provider Name (Legal Business Name): LIBERTY PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 W LIBERTY RD SUITE A
ANN ARBOR MI
48103-9746
US

IV. Provider business mailing address

3200 W LIBERTY RD SUITE A
ANN ARBOR MI
48103-9746
US

V. Phone/Fax

Practice location:
  • Phone: 734-994-5858
  • Fax: 734-994-4322
Mailing address:
  • Phone: 734-994-5858
  • Fax: 734-994-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301069944
License Number StateMI

VIII. Authorized Official

Name: DR. ANDREW JON SEILER
Title or Position: MEMBER
Credential: MD
Phone: 734-994-5858