Provider Demographics
NPI:1699767343
Name:FOREST HILLS PEDIATRIC ASSOCIATES, PC
Entity type:Organization
Organization Name:FOREST HILLS PEDIATRIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-949-4465
Mailing Address - Street 1:877 FOREST HILL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2325
Mailing Address - Country:US
Mailing Address - Phone:616-949-4465
Mailing Address - Fax:616-949-6191
Practice Address - Street 1:877 FOREST HILL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2325
Practice Address - Country:US
Practice Address - Phone:616-949-4465
Practice Address - Fax:616-949-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty