Provider Demographics
NPI:1720040215
Name:ORCHARD PEDIATRICS PC
Entity Type:Organization
Organization Name:ORCHARD PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLUNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-855-7510
Mailing Address - Street 1:6900 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-855-7510
Mailing Address - Fax:248-855-5626
Practice Address - Street 1:6900 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 315
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-855-7510
Practice Address - Fax:248-855-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty