Healthcare Provider Details

I. General information

NPI: 1275792301
Provider Name (Legal Business Name): MEDICAL ARTS PEDIATRICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SOUTH DR SUITE 341
MT PLEASANT MI
48858-3256
US

IV. Provider business mailing address

1201 SOUTH DR SUITE 341
MT PLEASANT MI
48858-3256
US

V. Phone/Fax

Practice location:
  • Phone: 989-779-5270
  • Fax: 989-779-5279
Mailing address:
  • Phone: 989-779-5270
  • Fax: 989-779-5279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSW053546
License Number StateMI

VIII. Authorized Official

Name: STEVEN G WALVISCH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 989-779-5270