Provider Demographics
NPI:1902972748
Name:CHILDRENS MEDICAL GROUP OF SAGINAW BAY PLLC
Entity Type:Organization
Organization Name:CHILDRENS MEDICAL GROUP OF SAGINAW BAY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:VANGELDEREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-892-5664
Mailing Address - Street 1:248 WASHINGTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5848
Mailing Address - Country:US
Mailing Address - Phone:989-892-5664
Mailing Address - Fax:989-892-0662
Practice Address - Street 1:248 WASHINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5848
Practice Address - Country:US
Practice Address - Phone:989-892-5664
Practice Address - Fax:989-892-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty