Healthcare Provider Details

I. General information

NPI: 1508306093
Provider Name (Legal Business Name): ROCKFORD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 12/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 NORTHLAND DR NE
ROCKFORD MI
49341
US

IV. Provider business mailing address

6116 NORTHLAND DR NE
ROCKFORD MI
49341
US

V. Phone/Fax

Practice location:
  • Phone: 616-259-6100
  • Fax: 616-259-5730
Mailing address:
  • Phone: 616-259-6100
  • Fax: 616-259-5730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101015010
License Number StateMI

VIII. Authorized Official

Name: TREW J STRANSKY
Title or Position: OWNER
Credential: DO
Phone: 616-259-6100