Provider Demographics
NPI:1326039165
Name:NORTH STAR PEDIATRICS, P.C.
Entity Type:Organization
Organization Name:NORTH STAR PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:WIELANDT
Authorized Official - Last Name:GOLLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-585-7827
Mailing Address - Street 1:9756 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9612
Mailing Address - Country:US
Mailing Address - Phone:317-585-7827
Mailing Address - Fax:317-585-7837
Practice Address - Street 1:9756 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9612
Practice Address - Country:US
Practice Address - Phone:317-585-7827
Practice Address - Fax:317-585-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty