Healthcare Provider Details

I. General information

NPI: 1639383110
Provider Name (Legal Business Name): FLINT CHILDREN'S CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 NORKO DR
FLINT MI
48507-3027
US

IV. Provider business mailing address

5205 NORKO DR
FLINT MI
48507-3027
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-0400
  • Fax: 810-733-8638
Mailing address:
  • Phone: 810-733-0400
  • Fax: 810-733-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMH051513
License Number StateMI

VIII. Authorized Official

Name: DR. MILTON G HOLLOWAY II
Title or Position: PRESIDENT
Credential: M.D.
Phone: 810-733-0400