Provider Demographics
NPI:1508999624
Name:PEDIATRIC ASSOCIATES OF BIG RAPIDS, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF BIG RAPIDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEKARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-796-4470
Mailing Address - Street 1:650 LINDEN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-1879
Mailing Address - Country:US
Mailing Address - Phone:231-796-4470
Mailing Address - Fax:231-796-1605
Practice Address - Street 1:650 LINDEN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-1879
Practice Address - Country:US
Practice Address - Phone:231-796-4470
Practice Address - Fax:231-796-1605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM407328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty