NPIMap

Organization Active NPI

Mikids Pediatrics, PC

  • Pediatrics Physician
  • Caledonia, MI
National Provider Identifier
1043722176
Registry record updated Mar 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
MIKIDS PEDIATRICS, PC
Practice address
7150 Kalamazoo Ave SE
Suite a
Caledonia, MI 49316
Phone
(616) 818-7454
Fax
(616) 818-7455
NPI assigned
Oct 30, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Garbacik
Title
Credentialing Specialist
Phone
(616) 235-4800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

7150 Kalamazoo Ave SE
Suite a
Caledonia, MI 49316

Mailing address

7150 Kalamazoo Ave SE
Suite a
Caledonia, MI 49316-9126
Phone (616) 818-7454

Other practice location 1

4540 Kalamazoo Ave SE
Kentwood, MI 49508-4625
Phone (616) 318-9677

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2142336Mikids Pediatrics, PC7150 Kalamazoo Ave SE Suite a, Caledonia, MI 49316Certificate of waiverJan 8, 2028

National Provider Directory

National Provider Directory

Locations

7150 Kalamazoo Ave SE
Caledonia, MI 49316
Phone (616) 333-1800

7150 Kalamazoo Ave SE
Ste A
Caledonia, MI 49316
Phone (616) 818-7454

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551657600000",
    "number": "1043722176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7150 KALAMAZOO AVE SE",
            "address_2": "SUITE A",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "493169126",
            "telephone_number": "616-818-7454",
            "fax_number": "616-818-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 KALAMAZOO AVE SE",
            "address_2": "SUITE A",
            "city": "CALEDONIA",
            "state": "MI",
            "postal_code": "49316",
            "telephone_number": "616-818-7454",
            "fax_number": "616-818-7455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4540 Kalamazoo Ave SE",
            "address_purpose": "LOCATION",
            "city": "Kentwood",
            "state": "MI",
            "postal_code": "495084625",
            "country_code": "US",
            "telephone_number": "616-318-9677",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MIKIDS PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2019-03-04",
        "status": "A",
        "authorized_official_last_name": "GARBACIK",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "616-235-4800"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caledonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.