Provider Demographics
NPI:1184814824
Name:MICHIGAN PEDIATRIC HOSPITALIST, PC
Entity Type:Organization
Organization Name:MICHIGAN PEDIATRIC HOSPITALIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENBOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-393-0166
Mailing Address - Street 1:926 WASHINGTON AVE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7725
Mailing Address - Country:US
Mailing Address - Phone:616-393-0166
Mailing Address - Fax:616-393-8821
Practice Address - Street 1:602 MICHIGAN AVE
Practice Address - Street 2:BOVEN BIRTH CENTER
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-393-0166
Practice Address - Fax:616-393-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty