Provider Demographics
NPI:1336234491
Name:PETOSKEY CHILD HEALTH ASSOCIATES, PC
Entity Type:Organization
Organization Name:PETOSKEY CHILD HEALTH ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SEAGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-487-2250
Mailing Address - Street 1:2390 MITCHELL PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8965
Mailing Address - Country:US
Mailing Address - Phone:231-487-2250
Mailing Address - Fax:231-348-7972
Practice Address - Street 1:2390 MITCHELL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8965
Practice Address - Country:US
Practice Address - Phone:231-487-2250
Practice Address - Fax:231-348-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty