Provider Demographics
NPI:1215058342
Name:CHILDREN'S HEALTH CARE, PLLC
Entity type:Organization
Organization Name:CHILDREN'S HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUMANA
Authorized Official - Middle Name:ANIS
Authorized Official - Last Name:BARODAWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-772-7774
Mailing Address - Street 1:709 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2207
Mailing Address - Country:US
Mailing Address - Phone:989-772-7774
Mailing Address - Fax:989-772-7220
Practice Address - Street 1:709 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2207
Practice Address - Country:US
Practice Address - Phone:989-772-7774
Practice Address - Fax:989-772-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068018208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherTAX IDENTIFICATION NUMBER