Healthcare Provider Details

I. General information

NPI: 1881862548
Provider Name (Legal Business Name): PEDIATRIC LOCUM CARE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD
TROY MI
48085-1117
US

IV. Provider business mailing address

PO BOX 251
LAPEER MI
48446-0251
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-5000
  • Fax:
Mailing address:
  • Phone: 810-664-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301048359
License Number StateMI

VIII. Authorized Official

Name: SYED G MOHIUDDIN
Title or Position: OWNER
Credential: MD
Phone: 810-664-4531