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NPI Code Detail

MEDICARE: PEDIATRICS PC

MEDICARE: PEDIATRICS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician

General Provider Information

NPI Number : 1265421069
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRICS PC
Provider Business Mailing Address
First Line : 670 MALL DR
Second Line :
City : PORTAGE
State : MI
Zip : 49024-2878
Country : US
Telephone Number : 269-327-1900
Fax Number : 269-327-1564
Provider Business Practice Location Address
First Line : 670 MALL DR
Second Line :
City : PORTAGE
State : MI
Zip : 49024-2878
Country : US
Telephone Number : 269-327-1900
Fax Number : 269-327-1564
Authorized Official
Title or Position : PRESIDENT
Name : STEPHEN R LULL
Credential : MD
Telephone Number : 269-327-1900
Provider Enumeration Date : 10/14/2005
Last Update Date : 08/22/2020

Similar Medicare Providers

1639177983 — ANN PATRICE SHEEHAN DNP, CPNP
Practice Location Address:
670 MALL DR
PORTAGE, MI
49024-2878
Practice Phone: 269-327-1900
Practice Fax: 269-327-1564
1033199674 — RANDALL L DYK MD
Practice Location Address:
670 MALL DR
PORTAGE, MI
49024-2878
Practice Phone: 269-491-3263
Practice Fax:
1437129095 — DAVID L OHMART M.D.
Practice Location Address:
670 MALL DR
PORTAGE, MI
49024-2878
Practice Phone: 269-327-1900
Practice Fax: 269-327-1564
1952371593 — STEPHEN R LULL M.D.
Practice Location Address:
670 MALL DR
PORTAGE, MI
49024-2878
Practice Phone: 269-327-1900
Practice Fax: 269-327-1564
1649240292 — MARK A BLAZEK M.D.
Practice Location Address:
670 MALL DR
PORTAGE, MI
49024-2878
Practice Phone: 269-327-1900
Practice Fax: 269-327-1564
1801867106 — KATHLEEN L LEMMEN M.D.
Practice Location Address:
670 MALL DR
PORTAGE, MI
49024-2878
Practice Phone: 269-327-1900
Practice Fax: 269-327-1564

Directions to “PEDIATRICS PC ” Practice Location

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