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General NPI Number Information
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NPI Number | 1194997825
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Entity Type | Organization
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Legal Business Name | PEDIATRICS PRIMARY CARE PLLC
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 4433 BYRON CENTER AVE SW PEDIATRICS PRIMARY CARE
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City | WYOMING
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State | MI
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Zip | 49519
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Country | US
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Telephone | 616-530-2846
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Fax | 616-530-2854
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Provider Business Mailing Address
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Address Line | 4433 BYRON CENTER AVE SW PEDIATRICS PRIMARY CARE
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City | WYOMING
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State | MI
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Zip | 49519
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Country | US
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Telephone |
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Fax | 616-530-2854
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | BUENAVENTURA CARMEN PEREYRA
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Credential | MD
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Telephone | 616-530-2846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301066298
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License Number State | MI
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