Provider Demographics
NPI:1174573471
Name:PEDIATRIC ASSOCIATES OF KENTWOOD
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF KENTWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOKERST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:2616-281-5800
Mailing Address - Street 1:4444 KALAMAZOO AVE SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4600
Mailing Address - Country:US
Mailing Address - Phone:616-281-5800
Mailing Address - Fax:616-281-5495
Practice Address - Street 1:4444 KALAMAZOO AVE SE
Practice Address - Street 2:SUITE 103
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-4600
Practice Address - Country:US
Practice Address - Phone:616-281-5800
Practice Address - Fax:616-281-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty