Organization
CEREAL CITY PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE THOMAS (OFFICE MANAGER)
(269) 969-8723
Entity
Organization
Contact information
Practice address
2545 CAPITAL AVE SW, BATTLE CREEK, MI 49015-7120
(269) 969-8723
(269) 969-8724
Mailing address
2545 CAPITAL AVE S.W., BATTLE CREEK, MI 49015
(269) 969-8723
(269) 969-8724
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350A349860
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/21/2006
Last updated
09/24/2008
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