| Breton Village Pediatrics And Family Medicine Pc | |
|
2460 Burton St Se Grand Rapids MI 49546-4800 | |
| (616) 295-5760 | |
| Not Available |
| Full Name | Breton Village Pediatrics And Family Medicine Pc |
|---|---|
| Speciality | Pediatrics |
| Location | 2460 Burton St Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Masuma F Macfield (PEDIATRICIAN) |
| Authorized Official Contact | 6167244972 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breton Village Pediatrics And Family Medicine Pc 4770 Blackberry Ct Ne 4770 Blackberry Ct Ne Grand Rapids MI 49525-9495 Ph: (616) 724-4972 | Breton Village Pediatrics And Family Medicine Pc 2460 Burton St Se Grand Rapids MI 49546-4800 Ph: (616) 295-5760 |
| NPI Number | 1447684857 |
|---|---|
| Provider Enumeration Date | 08/21/2013 |
| Last Update Date | 05/02/2019 |
| Medicare PECOS PAC ID | 2163654476 |
|---|---|
| Medicare Enrollment ID | O20140418000211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447684857 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 8305045032 (Michigan) | Secondary |
| 208000000X | Pediatrics | 4301084408 (Michigan) | Primary |
| Provider Name | Peter Sonjoy Macfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831311778 PECOS PAC ID: 9436243060 Enrollment ID: I20070913000396 |
| Provider Name | Quiana J Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477911865 PECOS PAC ID: 8921305160 Enrollment ID: I20160401001088 |
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