Healthcare Provider Details

I. General information

NPI: 1194792168
Provider Name (Legal Business Name): COUNTRY CREEK PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4986 N ADAMS RD SUITE C
ROCHESTER MI
48306-1416
US

IV. Provider business mailing address

4986 N ADAMS RD SUITE C
ROCHESTER MI
48306-1416
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-5601
  • Fax: 248-475-5632
Mailing address:
  • Phone: 248-475-5601
  • Fax: 248-475-5632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELZBIETA ANNA ROZMIEJ
Title or Position: MANAGER
Credential: M.D.
Phone: 248-475-5601