Healthcare Provider Details

I. General information

NPI: 1437488921
Provider Name (Legal Business Name): PURE JOY PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36880 WOODWARD AVE SUITE 101
BLOOMFIELD HILLS MI
48304-0919
US

IV. Provider business mailing address

36880 WOODWARD AVE SUITE 101
BLOOMFIELD HILLS MI
48304-0919
US

V. Phone/Fax

Practice location:
  • Phone: 248-220-2384
  • Fax: 248-630-2627
Mailing address:
  • Phone: 248-220-2384
  • Fax: 248-630-2627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301088258
License Number StateMI

VIII. Authorized Official

Name: DR. LA DONNA J. HENDRICKS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 248-421-9706