Healthcare Provider Details

I. General information

NPI: 1962522771
Provider Name (Legal Business Name): SOUTHWESTERN MICHIGAN NEONATOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 JOHN ST BOX 41
KALAMAZOO MI
49007-5341
US

IV. Provider business mailing address

601 JOHN ST BOX 41
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-341-6469
  • Fax: 269-341-6236
Mailing address:
  • Phone: 269-341-6469
  • Fax: 269-341-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301076137
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301042454
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301048451
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301046184
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number4301042801
License Number StateMI

VIII. Authorized Official

Name: JOAN SHARDA
Title or Position: FINANCIAL OFFICER
Credential: M.D.
Phone: 269-341-6469