Healthcare Provider Details

I. General information

NPI: 1093005613
Provider Name (Legal Business Name): KID KARE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6636 N. TELEGRAPH RD
DEARBORN HEIGHTS MI
48127
US

IV. Provider business mailing address

6636 N. TELEGRAPH RD
DEARBORN HEIGHTS MI
48127
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-3123
  • Fax: 313-274-3343
Mailing address:
  • Phone: 313-274-3123
  • Fax: 313-274-3343

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. HAISSAM GHALEB EL-TAKECH
Title or Position: OWNER
Credential: M.D.
Phone: 313-752-8987