Healthcare Provider Details

I. General information

NPI: 1821130980
Provider Name (Legal Business Name): GENESEE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5067 W BRISTOL RD SUITE J
FLINT MI
48507-2924
US

IV. Provider business mailing address

5067 W BRISTOL RD SUITE J
FLINT MI
48507-2924
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: MANAR HAMMOUD
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 810-720-1510