Healthcare Provider Details

I. General information

NPI: 1861967630
Provider Name (Legal Business Name): MONROE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 05/30/2022
Certification Date: 05/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1052 N MONROE ST
MONROE MI
48162-3113
US

IV. Provider business mailing address

1052 N MONROE ST
MONROE MI
48162-3113
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-9550
  • Fax:
Mailing address:
  • Phone: 734-242-9550
  • Fax:

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. FATIMA HASSAN
Title or Position: OWNER
Credential: MD
Phone: 734-242-9550