Healthcare Provider Details

I. General information

NPI: 1437100013
Provider Name (Legal Business Name): BEVERLY HILLS PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32100 TELEGRAPH RD SUITE 110
BINGHAM FARMS MI
48025-2452
US

IV. Provider business mailing address

32100 TELEGRAPH RD SUITE 110
BINGHAM FARMS MI
48025-2452
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-1221
  • Fax: 248-644-2748
Mailing address:
  • Phone: 248-644-1221
  • Fax: 248-644-2748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN MORRIS DORSEY JR.
Title or Position: OFFICER/PARTNER
Credential: M.D.
Phone: 248-644-1221