Pennant Physician Services
Pediatrics, Pediatric Cardiology in Grand Rapids, MI. Organization (NPI-2).
NPI number1245572007
StatusActive
Last updated in NPPESMar 20, 2013
Details
- NPI
- 1245572007
- Entity type
- Organization (NPI-2)
- Legal business name
- Pennant Physician Services
- Organization subpart
- No
- Enumeration date
- Mar 20, 2013
- Last updated
- Mar 20, 2013
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2080P0202X | Pediatrics, Pediatric Cardiology | – | – | Yes |
Practice location
555 Midtowne St NeSuite 310
Grand Rapids, MI 49503-5729
Phone 616-252-4765
Mailing address
2122 Health Dr SwSuite 230
Wyoming, MI 49519-9698
Authorized official
Frank E Belsito
Cmo
6162525211
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