Healthcare Provider Details

I. General information

NPI: 1073743506
Provider Name (Legal Business Name): MEDPEDS HEALTHCARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5889 BAY RD SUITE 105
SAGINAW MI
48604-2540
US

IV. Provider business mailing address

5889 BAY RD SUITE 105
SAGINAW MI
48604-2540
US

V. Phone/Fax

Practice location:
  • Phone: 989-501-5017
  • Fax:
Mailing address:
  • Phone: 989-501-5017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60516
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60516
License Number StateMI

VIII. Authorized Official

Name: LATONYA THOMAS-ROBINSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 989-501-5017