Organization
WATERFORD PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VICKI L INMAN (BILLING MGR)
(248) 666-4266
Entity
Organization
Contact information
Practice address
4185 HIGHLAND RD, WATERFORD, MI 48328
(248) 648-8930
(248) 648-8931
Mailing address
4185 HIGHLAND RD, WATERFORD, MI 48328
(248) 648-8930
(248) 648-8931
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MK057394
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021121
MIDWEST
—
01
—
0634011
BCBS
—
01
—
120911
CARECHOICES
—
01
—
15486
HEALTH PLAN
—
05
—
4149524
—
MI
01
—
C7543
MCARE
—
Enumeration date
07/30/2008
Last updated
07/30/2008
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