Healthcare Provider Details

I. General information

NPI: 1992084693
Provider Name (Legal Business Name): TENDER CARE PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58115 MAIN ST
NEW HAVEN MI
48048-2686
US

IV. Provider business mailing address

58115 MAIN ST
NEW HAVEN MI
48048-2686
US

V. Phone/Fax

Practice location:
  • Phone: 586-749-4444
  • Fax:
Mailing address:
  • Phone: 586-749-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301073327
License Number StateMI

VIII. Authorized Official

Name: ANNE MIYOUNG VONDRACHEK
Title or Position: PHYSICIAN
Credential: MD
Phone: 586-749-4444