Healthcare Provider Details

I. General information

NPI: 1134204993
Provider Name (Legal Business Name): ADULT & PEDIATRIC M D PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 CARPENTER ST SUITE 201
HAMTRAMCK MI
48212-9802
US

IV. Provider business mailing address

5332 MARLWOOD CT
WEST BLOOMFIELD MI
48323-2743
US

V. Phone/Fax

Practice location:
  • Phone: 313-909-3694
  • Fax:
Mailing address:
  • Phone: 313-909-3694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number5101015182
License Number StateMI

VIII. Authorized Official

Name: DR. MERAJ FATIMA YUNUS
Title or Position: OWNER
Credential: D.O.
Phone: 313-909-3694