Provider Demographics
NPI:1043561061
Name:PEDIATRIC ASSOCIATES OF ROCHESTER HILLS, PC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF ROCHESTER HILLS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-651-5454
Mailing Address - Street 1:930 W AVON RD
Mailing Address - Street 2:17
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2759
Mailing Address - Country:US
Mailing Address - Phone:248-651-5454
Mailing Address - Fax:248-651-3841
Practice Address - Street 1:930 W AVON RD
Practice Address - Street 2:17
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2759
Practice Address - Country:US
Practice Address - Phone:248-651-5454
Practice Address - Fax:248-651-3841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWC036541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty