Healthcare Provider Details

I. General information

NPI: 1366562142
Provider Name (Legal Business Name): WOODS PEDIATRICS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19925 VERNIER RD
HARPER WOODS MI
48225-1486
US

IV. Provider business mailing address

19925 VERNIER RD
HARPER WOODS MI
48225-1486
US

V. Phone/Fax

Practice location:
  • Phone: 313-886-3232
  • Fax: 313-886-1833
Mailing address:
  • Phone: 313-886-3232
  • Fax: 313-886-1833

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. SUSAN KESSLER
Title or Position: OFFICER
Credential: M.D
Phone: 313-886-3232