Healthcare Provider Details

I. General information

NPI: 1518185826
Provider Name (Legal Business Name): RIVER OAKS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 12/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20211 ANN ARBOR TRL
DEARBORN HEIGHTS MI
48127-2691
US

IV. Provider business mailing address

20211 ANN ARBOR TRL
DEARBORN HEIGHTS MI
48127-2691
US

V. Phone/Fax

Practice location:
  • Phone: 313-336-4444
  • Fax: 313-336-2355
Mailing address:
  • Phone: 313-336-4444
  • Fax: 313-336-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number055667
License Number StateMI

VIII. Authorized Official

Name: DR. NAZEM A ALHUSEIN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 313-336-4444