Healthcare Provider Details

I. General information

NPI: 1730393034
Provider Name (Legal Business Name): HURON VALLEY PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 S MILFORD RD
HIGHLAND MI
48357-4938
US

IV. Provider business mailing address

2632 S MILFORD RD
HIGHLAND MI
48357-4938
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-5510
  • Fax: 248-684-5220
Mailing address:
  • Phone: 248-684-5510
  • Fax: 248-684-5220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMB006783
License Number StateMI

VIII. Authorized Official

Name: LINDA DEVINE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 248-684-5510