Healthcare Provider Details

I. General information

NPI: 1336230788
Provider Name (Legal Business Name): SHIAWASSEE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W KING ST SUITE C
OWOSSO MI
48867-2100
US

IV. Provider business mailing address

802 W KING ST SUITE C
OWOSSO MI
48867-2100
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4848
  • Fax: 989-729-4849
Mailing address:
  • Phone: 989-729-4848
  • Fax: 989-729-4849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301029347
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704113660
License Number StateMI

VIII. Authorized Official

Name: BARBARA J MUNSON
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 989-729-4848