Provider Demographics
NPI:1508306093
Name:ROCKFORD PEDIATRICS, PC
Entity Type:Organization
Organization Name:ROCKFORD PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-901-1594
Mailing Address - Street 1:120 MARCELL DR NE STE C
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1362
Mailing Address - Country:US
Mailing Address - Phone:616-259-6100
Mailing Address - Fax:616-259-5730
Practice Address - Street 1:120 MARCELL DR NE STE C
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1362
Practice Address - Country:US
Practice Address - Phone:616-259-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015010208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty