Clyde Park Pediatrics, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301066741 Issued in MI

Legal business name

CLYDE PARK PEDIATRICS, P.C.

Practice address

3637 Clyde Park Ave SW Ste 4
Wyoming, MI 49509

Phone

(616) 808-3265

Fax

(616) 726-7019

NPI assigned

Jul 13, 2006

Last updated

Jun 10, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Flor Borrero, M.D.NPI 1548285299

Title

Owner

Phone

(616) 808-3265

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Flor L. Borrero, MD

  • Pediatrics Physician
  • Wyoming, MI
  • NPI 1548285299
  NPD (past) Authorized official

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1275558926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3637 CLYDE PARK AVE SW STE 4",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "49509",
            "telephone_number": "616-808-3265",
            "fax_number": "616-726-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3637 CLYDE PARK AVE SW STE 4",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "49509",
            "telephone_number": "616-808-3265",
            "fax_number": "616-726-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLYDE PARK PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "BORRERO",
        "authorized_official_first_name": "FLOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-808-3265",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301066741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Clements
• Carly Cleveland, COTA
• Anne Clocklin
• Erin Elizabeth Clover, PA-C
• Clyde Park Chiropractic, P.C.
• Allan G Coates, DO
• Joanne Renee Coates, MSN, FNP
• Sharyn Armstrong Coates, MSOTR/L, BCB-PMD
• Erin Cobb, NP-C
• Jodine Cole Meyer, LLP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2014; 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.