Healthcare Provider Details

I. General information

NPI: 1013046655
Provider Name (Legal Business Name): KARMO PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26206 W 12 MILE RD SUITE 106
SOUTHFIELD MI
48034-1754
US

IV. Provider business mailing address

26206 W 12 MILE RD SUITE 106
SOUTHFIELD MI
48034-1754
US

V. Phone/Fax

Practice location:
  • Phone: 248-354-1600
  • Fax: 248-354-1604
Mailing address:
  • Phone: 248-354-1600
  • Fax: 248-354-1604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TERESA BALL
Title or Position: CPC
Credential:
Phone: 734-839-6610