Healthcare Provider Details

I. General information

NPI: 1285719286
Provider Name (Legal Business Name): KIDZ CARE CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30795 23 MILE RD. SUITE 202
CHESTERFIELD MI
48047-5720
US

IV. Provider business mailing address

30795 23 MILE RD. SUITE 202
CHESTERFIELD MI
48047-5720
US

V. Phone/Fax

Practice location:
  • Phone: 586-421-1740
  • Fax: 586-421-1744
Mailing address:
  • Phone: 586-421-1740
  • Fax: 586-421-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOLLY MIRON
Title or Position: OFFICE MANAGER/BILLER
Credential:
Phone: 586-421-1740