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General NPI Number Information
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NPI Number | 1891321352
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Entity Type | Organization
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Legal Business Name | MUSKEGON PEDIATRICS, PLC
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 888 TERRACE ST
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City | MUSKEGON
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State | MI
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Zip | 49440-1220
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Country | US
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Telephone | 517-294-8741
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Fax |
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Provider Business Mailing Address
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Address Line | 16703 POND CRK
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City | SPRING LAKE
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State | MI
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Zip | 49456-9792
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Country | US
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Telephone | 517-294-8741
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. JENNIFER MARIE KING
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Credential | MD
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Telephone | 517-294-8741
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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 |
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License Number State |
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