Provider Demographics
NPI:1730320177
Name:PEDIATRIC NEPHROLOGY ASSOCIATES OF MICHIGAN PLC
Entity Type:Organization
Organization Name:PEDIATRIC NEPHROLOGY ASSOCIATES OF MICHIGAN PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRATICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-712-3471
Mailing Address - Street 1:5333 MCAULEY DRIVE
Mailing Address - Street 2:SUITE 4003
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1099
Mailing Address - Country:US
Mailing Address - Phone:734-712-3888
Mailing Address - Fax:
Practice Address - Street 1:5333 MCAULEY DRIVE
Practice Address - Street 2:SUITE 4003
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1099
Practice Address - Country:US
Practice Address - Phone:734-712-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric NephrologyGroup - Single Specialty