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NPI Code Detail

MEDICARE: SHELBY PEDIATRIC ASSOCIATES AND CHILD LUNG CENTER PC

MEDICARE: SHELBY PEDIATRIC ASSOCIATES AND CHILD LUNG CENTER PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianAR2460549MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124051990
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELBY PEDIATRIC ASSOCIATES AND CHILD LUNG CENTER PC
Provider Business Mailing Address
First Line : 15125 22 MILE RD
Second Line :
City : SHELBY TOWNSHIP
State : MI
Zip : 48315-4406
Country : US
Telephone Number : 586-532-0599
Fax Number : 586-566-8967
Provider Business Practice Location Address
First Line : 15125 22 MILE RD
Second Line :
City : SHELBY TOWNSHIP
State : MI
Zip : 48315-4406
Country : US
Telephone Number : 586-532-0599
Fax Number : 586-566-8967
Authorized Official
Title or Position : OFFICE MANAGER
Name : MARIA PELLERITO
Credential :
Telephone Number : 586-532-0599
Provider Enumeration Date : 07/07/2006
Last Update Date : 03/27/2024

Similar Medicare Providers

1134702079 — DR. GIDEON OKARI NYAKUNDI MD
Practice Location Address:
15125 22 MILE RD
SHELBY TOWNSHIP, MI
48315-4406
Practice Phone: 586-532-0599
Practice Fax:
1588655765 — DR. SALVATORE VENTIMIGLIA MD
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48315-4406
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1710968094 — DR. S BHIMSEN RAO MD
Practice Location Address:
15125 22 MILE RD
SHELBY TOWNSHIP, MI
48315-4406
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Practice Fax: 586-566-8967
1407837701 — DR. LEONIDAS P MOSCHOURIS MD
Practice Location Address:
15125 22 MILE RD
SHELBY TOWNSHIP, MI
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Practice Fax: 586-566-8967
1275939928 — MRS. KELLY LYNN DOBRZENIECKI NP-C
Practice Location Address:
15125 22 MILE RD
SHELBY TOWNSHIP, MI
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Practice Phone: 586-532-0599
Practice Fax: 586-566-8967
1417489402 — PAULINA MULTHAUPT
Practice Location Address:
15125 22 MILE RD
SHELBY TOWNSHIP, MI
48315-4406
Practice Phone: 586-532-0599
Practice Fax: 586-566-8967

Directions to “SHELBY PEDIATRIC ASSOCIATES AND CHILD LUNG CENTER PC ” Practice Location

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