Healthcare Provider Details

I. General information

NPI: 1306538889
Provider Name (Legal Business Name): WARRENDALE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17600 W WARREN AVE
DETROIT MI
48228-3509
US

IV. Provider business mailing address

17600 W WARREN AVE
DETROIT MI
48228-3509
US

V. Phone/Fax

Practice location:
  • Phone: 313-551-5141
  • Fax: 248-684-5510
Mailing address:
  • Phone: 313-551-5141
  • Fax: 248-684-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YASSER HASSANE
Title or Position: PHYSICIAN/OFFICE MANAGER
Credential: MD
Phone: 313-213-7538