| Center For Adolescent And Child Neurology | |
|
422 Plymouth Ave Ne Grand Rapids MI 49505-6028 | |
| (616) 294-0010 | |
| Not Available |
| Full Name | Center For Adolescent And Child Neurology |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 422 Plymouth Ave Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Olufemi Oluseun Soyode (OWNER) |
| Authorized Official Contact | 6162940010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Adolescent And Child Neurology 422 Plymouth Ave Ne Grand Rapids MI 49505-6028 Ph: (616) 294-0010 | Center For Adolescent And Child Neurology 422 Plymouth Ave Ne Grand Rapids MI 49505-6028 Ph: (616) 294-0010 |
| NPI Number | 1942620638 |
|---|---|
| Provider Enumeration Date | 04/21/2014 |
| Last Update Date | 02/17/2015 |
| Medicare PECOS PAC ID | 2264755156 |
|---|---|
| Medicare Enrollment ID | O20141230000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942620638 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0402X | Psychiatry & Neurology - Neurology With Special Qualifications In Child Neurology | (* (Not Available)) | Primary |
| Provider Name | Olufemi O Soyode |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1184735698 PECOS PAC ID: 9931391760 Enrollment ID: I20101012000167 |
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