CLYDE PARK PEDIATRICS, P.C. (NPI# 1275558926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275558926 |
| Entity Type | Organization |
| Organization Name | CLYDE PARK PEDIATRICS, P.C. |
| Practice Address |
3637 Clyde Park Ave Sw Ste 4 Wyoming MI 49509 |
| Practice Telephone | 6168083265 |
| Practice Fax Number | 6167267019 |
| Mailing Telephone | 6168083265 |
| Mailing Fax Number | 6167267019 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2014-06-10 |
| Authorized Official Name | FLOR BORRERO (OWNER) |
| Authorized Official Telephone | 6168083265 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 208000000X | Pediatrics | 4301066741 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
3637 CLYDE PARK AVE SW STE 4 |
| City | WYOMING |
| State | MI |
| Zip Code | 49509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023620713 | Lindsay Kayann Ottowitz | Behavior Technician | 1428 44th St. Sw, Wyoming, MI 49509 | 2020-08-23 |
| 1750990016 | Lindsay Alexandra Lyszczarz | Behavior Technician | 5281 Clyde Park Ave Se, Suite 2, Wyoming, MI 49509 | 2020-07-23 |
| 1033690409 | Courtney M Garner | Behavior Technician | 1428 44th Street, Wyoming, MI 49509 | 2018-08-23 |
| 1457857195 | Ashley Mae Autio | Case Manager/Care Coordinator | 795 36th Street, Wyoming, MI 49509 | 2018-04-02 |
| 1689124588 | Jacqeulyn Harmon | Behavioral Analyst | 2819 Peckheath Rd Sw Apt D, Wyoming, MI 49509 | 2016-10-04 |
| 1275988925 | Intsar Abdulahe | Social Worker | 1551 Charles Russell, Wyoming, MI 49509 | 2016-05-02 |
| 1992160071 | Concierge Home Care Services of West Michigan, LLC | Home Infusion | 1360 56th Street Sw, Wyoming, MI 49509 | 2015-12-16 |
| 1417349796 | Yashana Duncan | Case Manager/Care Coordinator | 225 Colrain St. Sw, Suite 2, Wyoming, MI 49509 | 2015-02-24 |
| 1710378377 | Rawm Vascular Access, Pllc | Internal Medicine | 1540 36th Street. Sw, Wyoming, MI 49509 | 2015-02-17 |
| 1366882755 | Kevin Timothy Solt | Dentist | 1535 44th St Sw Ste 200, Wyoming, MI 49509 | 2013-06-28 |
| Find all providers in zip 49509 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548285299 | Flor L. Borrero | Pediatrics | 3637 Clyde Park Ave Sw, Ste. 4, Wyoming, MI 49509-4095 | 2006-07-13 |
| 1780657478 | Megan Marie Edison | Pediatrics | 1200 56th St Sw, C/o Brookville Pediatric & Internal Medicine, PC, Wyoming, MI 49509-9704 | 2006-02-11 |
| 1528051406 | Rubina A Zaman | Pediatrics | 913 Wyoming Ave Rear, Wyoming, PA 18644-1328 | 2005-08-25 |
| 1588028955 | Kevin Anthony Brueske | Pediatrics | 5200 Fairview Blvd, Wyoming, MN 55092 | 2016-04-11 |
| 1740509371 | Sarah Barnes Kinsella | Pediatrics | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2010-05-21 |
| 1336470947 | Rubina A Zaman, Md LLC | Pediatrics | 913 Wyoming Ave Rear, Wyoming, PA 18644-1328 | 2010-01-21 |
| 1952537979 | Amy Beth Vislisel | Pediatrics | 5200 Fairview Blvd, Wyoming, MN 55092-8013 | 2009-06-04 |
| 1538378518 | Meghan Coleman | Pediatrics | 2215 44th St Sw, Wyoming, MI 49519-6439 | 2007-05-22 |
| 1629113972 | Richard A. Switzer, M.d., P.C. | Pediatrics | 4166 56th St Sw, Wyoming, MI 49418-9352 | 2007-02-21 |
| 1245253657 | Tiffany Allyn Letts | Pediatrics | 2215 44th St Sw, Wyoming, MI 49519-6439 | 2006-07-26 |
| Find all providers in WYOMING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.