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General NPI Number Information
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NPI Number | 1992937148
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Entity Type | Organization
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Legal Business Name | HILLSDALE PEDIATRICS CLINIC PC
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 451 HIDDEN MEADOWS DR SUITE 200
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City | HILLSDALE
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State | MI
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Zip | 49242-9812
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Country | US
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Telephone | 517-437-8325
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Fax | 517-437-8327
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Provider Business Mailing Address
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Address Line | 1131 N OSSEO RD P.O. BOX 187
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City | HILLSDALE
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State | MI
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Zip | 49242-9714
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Country | US
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Telephone | 517-523-3695
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Fax | 517-523-3311
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL SACKMAN
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Credential | M.D.
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Telephone | 517-437-8325
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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 | MS086960
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License Number State | MI
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