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General NPI Number Information
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NPI Number | 1457893430
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Entity Type | Organization
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Legal Business Name | BRANCH PEDIATRICS
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Dates
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Enumeration Date | 11/08/2016
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Last Update Date | 09/17/2021
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Provider Practice Location Address
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Address Line | 390 E CHICAGO ST
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City | COLDWATER
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State | MI
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Zip | 49036-2062
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Country | US
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Telephone | 517-924-1465
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Fax | 517-924-1467
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Provider Business Mailing Address
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Address Line | 390 E CHICAGO ST
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City | COLDWATER
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State | MI
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Zip | 49036-2062
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Country | US
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Telephone | 517-924-1465
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Fax | 517-924-1467
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. MEHALAI ARIVOLI
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Credential | M.D
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Telephone | 517-924-1465
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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 | 4301077145
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License Number State | MI
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