Provider Demographics
NPI:1609479138
Name:THE PEDIATRIC PLACE PC
Entity Type:Organization
Organization Name:THE PEDIATRIC PLACE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SWEETY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-874-2060
Mailing Address - Street 1:3020 S GENESEE RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1420
Mailing Address - Country:US
Mailing Address - Phone:810-744-3321
Mailing Address - Fax:
Practice Address - Street 1:3020 S GENESEE RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48519-1420
Practice Address - Country:US
Practice Address - Phone:810-744-3321
Practice Address - Fax:810-744-2850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty