Provider Demographics
NPI:1568633253
Name:LIBERTY PEDIATRICS PLLC
Entity Type:Organization
Organization Name:LIBERTY PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JON
Authorized Official - Last Name:SEILER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-994-5858
Mailing Address - Street 1:3200 W LIBERTY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9746
Mailing Address - Country:US
Mailing Address - Phone:734-994-5858
Mailing Address - Fax:734-994-4322
Practice Address - Street 1:3200 W LIBERTY RD
Practice Address - Street 2:SUITE A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9746
Practice Address - Country:US
Practice Address - Phone:734-994-5858
Practice Address - Fax:734-994-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty