Provider Demographics
NPI:1417545773
Name:PETOSKEY PEDIATRICS, PC
Entity Type:Organization
Organization Name:PETOSKEY PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANDWERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-347-8382
Mailing Address - Street 1:345 N DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9416
Mailing Address - Country:US
Mailing Address - Phone:231-347-8382
Mailing Address - Fax:231-347-6628
Practice Address - Street 1:345 N DIVISION RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9416
Practice Address - Country:US
Practice Address - Phone:231-347-8382
Practice Address - Fax:231-347-6628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty