Healthcare Provider Details
I. General information
NPI: 1912097130
Provider Name (Legal Business Name): PEDIATRIC & ADOLESCENT CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
41400 DEQUINDRE RD SUITE 121
STERLING HEIGHTS MI
48314-3763
US
IV. Provider business mailing address
41400 DEQUINDRE RD SUITE 121
STERLING HEIGHTS MI
48314-3763
US
V. Phone/Fax
- Phone: 586-731-1500
- Fax: 586-731-1363
- Phone: 586-731-1500
- Fax: 586-731-1363
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ARUNA
J.
PAREKH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-731-1500