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General NPI Number Information
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NPI Number | 1528157344
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ASSOCIATES OF LIVINGSTON, PLLC
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 8548 W GRAND RIVER AVE
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City | BRIGHTON
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State | MI
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Zip | 48116-2326
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Country | US
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Telephone | 810-229-7257
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Fax | 810-229-4069
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Provider Business Mailing Address
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Address Line | 8548 W GRAND RIVER AVE
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City | BRIGHTON
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State | MI
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Zip | 48116-2326
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Country | US
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Telephone | 810-229-7257
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Fax | 810-229-4069
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Authorized Official
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Title or Position | PEDIATRICIAN/PARTNER
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Name | DR. DEBORAH A MCEWEN
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Credential | M.D.
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Telephone | 810-229-7257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301074426
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License Number State | MI
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