Healthcare Provider Details

I. General information

NPI: 1902815186
Provider Name (Legal Business Name): MASON PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E COLUMBIA ST SUITE 3
MASON MI
48854-1381
US

IV. Provider business mailing address

PO BOX 10
MASON MI
48854-0010
US

V. Phone/Fax

Practice location:
  • Phone: 517-244-8950
  • Fax: 517-244-8951
Mailing address:
  • Phone: 517-676-9788
  • Fax: 517-676-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38957
License Number StateMI

VIII. Authorized Official

Name: LEWIS DAVID RESNICK
Title or Position: PRESIDENT
Credential: MD
Phone: 517-244-8950