Healthcare Provider Details

I. General information

NPI: 1720493364
Provider Name (Legal Business Name): THE PEDIATRIC TEAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 06/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W MAPLE RD SUITE 111
CLAWSON MI
48017-1000
US

IV. Provider business mailing address

909 W MAPLE RD SUITE 111
CLAWSON MI
48017-1000
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-5437
  • Fax: 248-288-5449
Mailing address:
  • Phone: 248-288-5437
  • Fax: 248-288-5449

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. PETER T MULLER
Title or Position: SOLE OWNER
Credential: MD
Phone: 248-288-5437