Provider Demographics
NPI:1124137534
Name:DOWNRIVER PEDIATRIC ASSOCIATES P.C.
Entity type:Organization
Organization Name:DOWNRIVER PEDIATRIC ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIONISIA
Authorized Official - Middle Name:ATIENZA
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-671-9800
Mailing Address - Street 1:23050 WEST RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1472
Mailing Address - Country:US
Mailing Address - Phone:734-671-9800
Mailing Address - Fax:734-671-7690
Practice Address - Street 1:23050 WEST RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1472
Practice Address - Country:US
Practice Address - Phone:734-671-9800
Practice Address - Fax:734-671-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty