Provider Demographics
NPI:1962522771
Name:SOUTHWESTERN MICHIGAN NEONATOLOGY, P.C.
Entity type:Organization
Organization Name:SOUTHWESTERN MICHIGAN NEONATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-341-6469
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 41
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-6469
Mailing Address - Fax:269-341-6236
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:BOX 41
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-6469
Practice Address - Fax:269-341-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010428012080N0001X
MI43010761372080N0001X
MI43010424542080N0001X
MI43010484512080N0001X
MI43010461842080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty