Healthcare Provider Details

I. General information

NPI: 1457796971
Provider Name (Legal Business Name): CAMPBELL PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CAMPBELL RD SUITE 5
ROYAL OAK MI
48067-1570
US

IV. Provider business mailing address

PO BOX 99148
TROY MI
48099-9148
US

V. Phone/Fax

Practice location:
  • Phone: 248-629-9146
  • Fax: 810-233-9710
Mailing address:
  • Phone: 810-233-7103
  • Fax: 810-233-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301054627
License Number StateMI

VIII. Authorized Official

Name: RASHED A HASAN
Title or Position: OWNER
Credential: MD
Phone: 248-417-3890