Healthcare Provider Details

I. General information

NPI: 1609874643
Provider Name (Legal Business Name): SHORELINE PEDIATRICS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 HARVEY ST SUITE 201
MUSKEGON MI
49442-4274
US

IV. Provider business mailing address

2680 VULCAN ST
NORTON SHORES MI
49444-2344
US

V. Phone/Fax

Practice location:
  • Phone: 231-773-7837
  • Fax: 231-773-7943
Mailing address:
  • Phone: 231-773-7837
  • Fax: 231-773-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LEANNE KOLENDA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 231-773-7837