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General NPI Number Information
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NPI Number | 1437692472
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Entity Type | Organization
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Legal Business Name | LINCOLN STREET PEDIATRICS PLLC
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 701 S LINCOLN ST
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City | BAY CITY
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State | MI
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Zip | 48708-7412
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Country | US
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Telephone | 989-895-9876
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Fax | 989-895-9780
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Provider Business Mailing Address
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Address Line | 701 S LINCOLN ST
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City | BAY CITY
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State | MI
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Zip | 48708-7412
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Country | US
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Telephone | 989-895-9876
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Fax | 989-895-9780
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NEIL COREY GIBSON
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Credential |
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Telephone | 989-895-9876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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