Healthcare Provider Details

I. General information

NPI: 1114322559
Provider Name (Legal Business Name): KIDS FIRST PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 E 9 MILE RD STE 1
HAZEL PARK MI
48030-1854
US

IV. Provider business mailing address

350 E 9 MILE RD STE 1
HAZEL PARK MI
48030-1854
US

V. Phone/Fax

Practice location:
  • Phone: 248-397-8031
  • Fax: 248-397-8320
Mailing address:
  • Phone: 248-397-8031
  • Fax: 248-397-8320

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. AMI ANNA HATTA
Title or Position: OWNER
Credential: MD
Phone: 248-397-8031