Healthcare Provider Details

I. General information

NPI: 1992919203
Provider Name (Legal Business Name): WEST BLOOMFIELD PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 FARMINGTON ROAD SUITE TEN
W BLOOMFIELD MI
48322
US

IV. Provider business mailing address

46325 WEST TWELVE MILE ROAD SUITE 240
NOVI MI
48377
US

V. Phone/Fax

Practice location:
  • Phone: 248-788-1200
  • Fax: 248-788-2346
Mailing address:
  • Phone: 248-596-1000
  • Fax: 248-305-8250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301086791
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301076640
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101006183
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301068662
License Number StateMI

VIII. Authorized Official

Name: DR. STEVEN B GLICKFIELD
Title or Position: PHYSICIAN
Credential: DO
Phone: 248-788-1200