Healthcare Provider Details

I. General information

NPI: 1306003538
Provider Name (Legal Business Name): GREENWOOD PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W FRANKLIN ST SUITE 1
JACKSON MI
49201-1674
US

IV. Provider business mailing address

720 W FRANKLIN ST SUITE 1
JACKSON MI
49201-1674
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-9104
  • Fax: 517-784-9107
Mailing address:
  • Phone: 517-784-9104
  • Fax: 517-784-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNH033036
License Number StateMI

VIII. Authorized Official

Name: DR. NASEER HUMAYUN
Title or Position: OWNER
Credential: M.D.38
Phone: 517-784-9104