Pediatrics PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PEDIATRICS PC

Practice address

670 Mall Dr
Portage, MI 49024-2878

Phone

(269) 327-1900

Fax

(269) 327-1564

NPI assigned

Oct 14, 2005

Organization subpart

No

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

Authorized official

Name

Stephen R Lull, MD

Title

President

Phone

(269) 327-1900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265421069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 MALL DR",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490242878",
            "telephone_number": "269-327-1900",
            "fax_number": "269-327-1564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 MALL DR",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490242878",
            "telephone_number": "269-327-1900",
            "fax_number": "269-327-1564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LULL",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-327-1900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jasmine Patterson
• Cynthia Pawlicki
• Andrea Nicole Peake, MSN, RN, PMHNP
• Purvi Peake, PHARMD
• Pearle Vision Inc
• Pei Wei Linda Lin DMD PLLC
• Philip Pelton
• Kenneth Penaherrera Quiroz
• Shaly M Penrod, LMSW
• Kaitlin Peot

• Pediatrics Physician in Portage, MI
• Providers in Portage, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.