Healthcare Provider Details

I. General information

NPI: 1295836096
Provider Name (Legal Business Name): ABC PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4288 THREE MILE ROAD
WALKER MI
49534
US

IV. Provider business mailing address

4288 THREE MILE ROAD
WALKER MI
49534
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-3677
  • Fax: 616-459-6850
Mailing address:
  • Phone: 616-458-3677
  • Fax: 616-459-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CINDI TIMMER-WALKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-458-3677