OrganizationClyde Park Pediatrics, P.C.PediatricsAllopathic & Osteopathic PhysiciansPractice Address3637 Clyde Park Ave SW Ste 4, Wyoming, MI 49509(616) 808-3265PECOS EnrollmentBased on the most recent information from CMS, provider Clyde Park Pediatrics, P.C. does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1275558926Provider TypeOrganizationFull NameClyde Park Pediatrics, P.C.SubpartNoEnumeration Date7/13/2006Last Updated6/10/2014Contact InformationPractice LocationPractice Address3637 Clyde Park Ave SW Ste 4, Wyoming, MI 49509Phone(616) 808-3265Fax(616) 726-7019Mailing LocationMailing Address3637 Clyde Park Ave SW Ste 4, Wyoming, MI 49509Phone(616) 808-3265Fax(616) 726-7019Authorized OfficialNameBorrero, Flor (Owner)Phone(616) 808-3265Provider TaxonomiesCodeDescriptionLicenseCode208000000XPrimaryDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicense4301066741MichiganCode208000000XDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseUnlisted Issuer