MEDICARE: PEDIATRIC ASSOCIATES OF LIVINGSTON, PLLC

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
1	208000000X	Pediatrics Physician	4301074426	MI

General Provider Information

NPI Number	:	1528157344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC ASSOCIATES OF LIVINGSTON, PLLC

Provider Business Mailing Address
First Line	:	8548 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2326
Country	:	US
Telephone Number	:	810-229-7257
Fax Number	:	810-229-4069

Provider Business Practice Location Address
First Line	:	8548 W GRAND RIVER AVE
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48116-2326
Country	:	US
Telephone Number	:	810-229-7257
Fax Number	:	810-229-4069

Authorized Official
Title or Position	:	PEDIATRICIAN/PARTNER
Name	:	DR. DEBORAH A MCEWEN
Credential	:	M.D.
Telephone Number	:	810-229-7257

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/12/2008

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