Organization
PEDIATRIC & ADOLESCENT HEALTHCARE ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL NIDIFFER MD (OWNER)
(906) 225-3925
Entity
Organization
Contact information
Practice address
1414 W FAIR AVE, SUITE 226, MARQUETTE, MI 49855-2675
(906) 225-3925
(906) 225-4838
Mailing address
1414 W FAIR AVE, SUITE 226, MARQUETTE, MI 49855-2675
(906) 225-3925
(906) 225-4838
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
030113
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3108394
—
MI
Enumeration date
02/01/2008
Last updated
02/01/2008
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