Anita Bridget Sebastian, D.O.
Individual provider Active NPI Pediatrics Physician · Rockford, MI
NPI 1306070529 · NPPES record last updated Dec 27, 2024
Key facts
- NPI
- 1306070529
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 5101020661 (MI)
- Practice address
- 6116 Northland Dr NE
Rockford, MI 49341 - Phone
- (616) 259-6100
- Fax
- (616) 259-5730
- NPI assigned
- May 4, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181204003835 | MI | Order and Referring Only - Pediatric Medicine |
5092059832 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT011300 | PA | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rockford Pediatrics | Pediatrics | Current |
Accepting new patients |
Locations
6116 Northland Dr NE
Rockford, MI 49341
Phone (616) 259-6100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | OT011300 | PA | |
| Pediatrics Physician | 208000000X | 5101020661 | MI | Yes |
Addresses
Primary practice location
6116 Northland Dr NE
Rockford, MI 49341
Mailing address
6116 Northland Dr NE
Rockford, MI 49341
Phone (616) 259-6100
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All providers in Rockford, MI · Pediatrics Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.