Healthcare Provider Details

I. General information

NPI: 1215058342
Provider Name (Legal Business Name): CHILDREN'S HEALTH CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S ADAMS ST
MT PLEASANT MI
48858-2207
US

IV. Provider business mailing address

709 S ADAMS ST
MT PLEASANT MI
48858-2207
US

V. Phone/Fax

Practice location:
  • Phone: 989-772-7774
  • Fax: 989-772-7220
Mailing address:
  • Phone: 989-772-7774
  • Fax: 989-772-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301068018
License Number StateMI

VIII. Authorized Official

Name: MRS. RUMANA ANIS BARODAWALLA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 989-772-7774