Provider Demographics
NPI:1194792168
Name:COUNTRY CREEK PEDIATRICS, PLLC
Entity type:Organization
Organization Name:COUNTRY CREEK PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELZBIETA
Authorized Official - Middle Name:ANNA
Authorized Official - Last Name:ROZMIEJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-475-5601
Mailing Address - Street 1:4986 N ADAMS RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48306-1416
Mailing Address - Country:US
Mailing Address - Phone:248-475-5601
Mailing Address - Fax:248-475-5632
Practice Address - Street 1:4986 N ADAMS RD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48306-1416
Practice Address - Country:US
Practice Address - Phone:248-475-5601
Practice Address - Fax:248-475-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty