NPIMap

Organization Active NPI

Shoreline Pediatrics PLC

  • Pediatrics Physician
  • Muskegon, MI
National Provider Identifier
1609874643
Registry record updated Apr 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
SHORELINE PEDIATRICS PLC
Practice address
684 Harvey St
Suite 201
Muskegon, MI 49442-4274
Phone
(231) 773-7837
Fax
(231) 773-7943
NPI assigned
Jul 13, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2023

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

Authorized official

Name
Mrs. Leanne Kolenda
Title
Practice Manager
Phone
(231) 773-7837

Specialties & licenses 1

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

Addresses

Primary practice location

684 Harvey St
Suite 201
Muskegon, MI 49442-4274

Mailing address

2680 Vulcan St
Norton Shores, MI 49444-2344
Phone (231) 773-7837

Other identifiers 1

IdentifierTypeStateIssuer
500F113130OtherMIBCBS MICHIGAN

National Provider Directory

National Provider Directory

Locations

684 Harvey St
Ste 201
Muskegon, MI 49442
Phone (231) 773-7837

2680 Vulcan St
Norton Shores, MI 49444

Practitioners & affiliated clinicians

Practitioners 7

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": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681430400000",
    "number": "1609874643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2680 VULCAN ST",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494442344",
            "telephone_number": "231-773-7837",
            "fax_number": "231-773-7943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 HARVEY ST",
            "address_2": "SUITE 201",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494424274",
            "telephone_number": "231-773-7837",
            "fax_number": "231-773-7943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE PEDIATRICS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A",
        "authorized_official_last_name": "KOLENDA",
        "authorized_official_first_name": "LEANNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "231-773-7837",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MICHIGAN",
            "identifier": "500F113130",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; 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.