Healthcare Provider Details

I. General information

NPI: 1093159105
Provider Name (Legal Business Name): PEDIATRIC & ADOLESCENT ADVANCE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 S LINDEN RD STE 3A
FLINT MI
48532-3459
US

IV. Provider business mailing address

8143 S SAGINAW ST SUITE 2
GRAND BLANC MI
48439-1825
US

V. Phone/Fax

Practice location:
  • Phone: 810-410-4869
  • Fax:
Mailing address:
  • Phone: 810-584-7689
  • Fax:

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. FAISAL M MAWRI
Title or Position: OWNER
Credential: M.D.
Phone: 810-877-4908