Provider Demographics
NPI:1902815186
Name:MASON PEDIATRICS
Entity Type:Organization
Organization Name:MASON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-244-8950
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-0010
Mailing Address - Country:US
Mailing Address - Phone:517-676-9788
Mailing Address - Fax:517-676-3438
Practice Address - Street 1:800 E COLUMBIA ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1381
Practice Address - Country:US
Practice Address - Phone:517-244-8950
Practice Address - Fax:517-244-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38957208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty