Healthcare Provider Details

I. General information

NPI: 1740227743
Provider Name (Legal Business Name): ALCESA ABELGAS BACKOS MD FAAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL OF MI 3950 BEAUBIEN
DETROIT MI
48201
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST UHC 5D MAILBOX 226 UNIVERSITY PEDIATRICIANS
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-832-8290
  • Fax: 313-993-0081
Mailing address:
  • Phone: 313-745-4405
  • Fax: 313-966-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301048246
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number4301048246
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: