NPIMap

Organization Active NPI

Waterford Pediatrics

  • General Practice Physician
  • Waterford, MI
National Provider Identifier
1104082148
Registry record updated Jul 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
MK057394 Issued in MI
Legal business name
WATERFORD PEDIATRICS
Practice address
4185 Highland Rd
Waterford, MI 48328
Phone
(248) 648-8930
Fax
(248) 648-8931
NPI assigned
Jul 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2008

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

Authorized official

Name
Mrs. Vicki L Inman
Title
Billing MGR
Phone
(248) 666-4266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X MK057394 MI Primary

Addresses

Primary practice location

4185 Highland Rd
Waterford, MI 48328

Mailing address

4185 Highland Rd
Waterford, MI 48328
Phone (248) 648-8930

Other identifiers 6

IdentifierTypeStateIssuer
4149524MedicaidMI
021121OtherMIDWEST
C7543OtherMCARE
0634011OtherBCBS
120911OtherCARECHOICES
15486OtherHEALTH PLAN

National Provider Directory

National Provider Directory

Locations

4185 Highland Rd
Waterford, MI 48328
Phone (248) 648-8930

Practitioners & affiliated clinicians

Practitioners 1

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": "1217376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1104082148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4185 HIGHLAND RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "48328",
            "telephone_number": "248-648-8930",
            "fax_number": "248-648-8931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4185 HIGHLAND RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "48328",
            "telephone_number": "248-648-8930",
            "fax_number": "248-648-8931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-30",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "INMAN",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING MGR",
        "authorized_official_telephone_number": "248-666-4266",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "MI",
            "license": "MK057394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4149524",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWEST",
            "identifier": "021121",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "C7543",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0634011",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARECHOICES",
            "identifier": "120911",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN",
            "identifier": "15486",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.