CLYDE PARK PEDIATRICS P.C. NPI 1275558926

NPI Information

  • NPI: 1275558926
  • Provider Name: CLYDE PARK PEDIATRICS, P.C.
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • Address: 3637 CLYDE PARK AVE SW STE 4
    WYOMING, MI
    ZIP 49509
  • Phone: (616) 808-3265

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NPI Details

CLYDE PARK PEDIATRICS, P.C. is a pediatrics in Wyoming, MI. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. CLYDE PARK PEDIATRICS, P.C. NPI is 1275558926. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3637 CLYDE PARK AVE SW STE 4
WYOMING, MI
ZIP 49509
Phone: (616) 808-3265
Fax: (616) 726-7019

The provider's authorized official is Flor Borrero .
The authorized official title is Owner and has the following contact phone number (616) 808-3265.

The enumeration date for this NPI number is 7/13/2006 and was last updated on 6/10/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatricsNo
2208000000XPediatrics4301066741MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1D48289MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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