Provider Demographics
NPI:1275792301
Name:MEDICAL ARTS PEDIATRICS, PLC
Entity Type:Organization
Organization Name:MEDICAL ARTS PEDIATRICS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALVISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-779-5270
Mailing Address - Street 1:1201 SOUTH DR
Mailing Address - Street 2:SUITE 341
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3256
Mailing Address - Country:US
Mailing Address - Phone:989-779-5270
Mailing Address - Fax:989-779-5279
Practice Address - Street 1:1201 SOUTH DR
Practice Address - Street 2:SUITE 341
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3256
Practice Address - Country:US
Practice Address - Phone:989-779-5270
Practice Address - Fax:989-779-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISW053546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0371044OtherBCBS
MI4875756Medicaid
MI0370053OtherBCBS
MI4344387Medicaid