Organization
PARKSIDE PEDIATRIC CLINIC,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIKINENI V RAO MD (PRESIDENT)
(517) 787-4332
Entity
Organization
Contact information
Practice address
2100 4TH ST, JACKSON, MI 49203-4518
(517) 787-4332
(517) 787-4861
Mailing address
2100 4TH ST, JACKSON, MI 49203-4518
(517) 787-4332
(517) 787-4861
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301 031905
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1379549
—
MI
Enumeration date
07/01/2009
Last updated
07/01/2009
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