Provider Demographics
NPI:1174639298
Name:CASCADE PEDIATRICS LLP
Entity Type:Organization
Organization Name:CASCADE PEDIATRICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-940-3168
Mailing Address - Street 1:5150 CASCADE RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3794
Mailing Address - Country:US
Mailing Address - Phone:616-940-3168
Mailing Address - Fax:616-940-3352
Practice Address - Street 1:5150 CASCADE RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3794
Practice Address - Country:US
Practice Address - Phone:616-940-3168
Practice Address - Fax:616-940-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350D16208OtherBCBS MICHIGAN