Provider Demographics
NPI:1992084693
Name:TENDER CARE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:TENDER CARE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MIYOUNG
Authorized Official - Last Name:VONDRACHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-749-4444
Mailing Address - Street 1:58115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48048-2686
Mailing Address - Country:US
Mailing Address - Phone:586-749-4444
Mailing Address - Fax:
Practice Address - Street 1:58115 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MI
Practice Address - Zip Code:48048-2686
Practice Address - Country:US
Practice Address - Phone:586-749-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073327208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty