Healthcare Provider Details

I. General information

NPI: 1376756239
Provider Name (Legal Business Name): HIGHLAND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W HIGHLAND RD STE 100
HIGHLAND MI
48357-4574
US

IV. Provider business mailing address

208 W HIGHLAND RD STE 100
HIGHLAND MI
48357-4574
US

V. Phone/Fax

Practice location:
  • Phone: 248-889-9467
  • Fax: 586-773-1211
Mailing address:
  • Phone: 248-889-9467
  • Fax: 586-773-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAI064238
License Number StateMI

VIII. Authorized Official

Name: DR. ARDESHIR IRANI
Title or Position: PHYSICIAN
Credential: MD
Phone: 586-773-1823