Healthcare Provider Details

I. General information

NPI: 1447217732
Provider Name (Legal Business Name): GENESEE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G5119 W BRISTOL ROAD SUITE A
FLINT MI
48507
US

IV. Provider business mailing address

G5119 W BRISTOL ROAD SUITE A
FLINT MI
48507
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-1510
  • Fax: 810-720-1726
Mailing address:
  • Phone: 810-720-1510
  • Fax: 810-720-1726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301067983
License Number StateMI

VIII. Authorized Official

Name: MRS. MANAR HAMMOUD
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 810-720-1510