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General NPI Number Information
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NPI Number | 1447684857
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Entity Type | Organization
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Legal Business Name | MACFIELD PEDIATRICS AND FAMILY MEDICINE PC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 05/02/2019
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Provider Practice Location Address
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Address Line | 2460 BURTON ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-4800
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Country | US
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Telephone | 616-295-5760
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Fax |
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Provider Business Mailing Address
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Address Line | 4770 BLACKBERRY CT NE 4770 BLACKBERRY CT NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9495
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Country | US
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Telephone | 616-724-4972
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. MASUMA F MACFIELD
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Credential | M.D.
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Telephone | 616-724-4972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 8305045032
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301084408
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License Number State | MI
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