Healthcare Provider Details

I. General information

NPI: 1508999624
Provider Name (Legal Business Name): PEDIATRIC ASSOCIATES OF BIG RAPIDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LINDEN ST SUITE 4
BIG RAPIDS MI
49307-1879
US

IV. Provider business mailing address

650 LINDEN ST SUITE 4
BIG RAPIDS MI
49307-1879
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-4470
  • Fax: 231-796-1605
Mailing address:
  • Phone: 231-796-4470
  • Fax: 231-796-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMM407328
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL R MEKARU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 231-796-4470