Provider Demographics
NPI:1043722176
Name:MIKIDS PEDIATRICS, PC
Entity Type:Organization
Organization Name:MIKIDS PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBACIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-235-4800
Mailing Address - Street 1:7150 KALAMAZOO AVE SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9126
Mailing Address - Country:US
Mailing Address - Phone:616-818-7454
Mailing Address - Fax:616-818-7455
Practice Address - Street 1:7150 KALAMAZOO AVE SE
Practice Address - Street 2:SUITE A
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316
Practice Address - Country:US
Practice Address - Phone:616-818-7454
Practice Address - Fax:616-818-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty