Healthcare Provider Details

I. General information

NPI: 1700519444
Provider Name (Legal Business Name): ICARE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 WOODLAKE DR STE 380A
OKEMOS MI
48864-6017
US

IV. Provider business mailing address

3598 CABARET TRL
OKEMOS MI
48864-4082
US

V. Phone/Fax

Practice location:
  • Phone: 517-775-8240
  • Fax:
Mailing address:
  • Phone:
  • 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: FAREEHA NAZ
Title or Position: OWNER
Credential: MD
Phone: 517-775-8240