Healthcare Provider Details

I. General information

NPI: 1245453125
Provider Name (Legal Business Name): MACOMB PEDIATRIC ASSOCIATEA P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29703 HOOVER RD
WARREN MI
48093-8901
US

IV. Provider business mailing address

29703 HOOVER
WARREN MI
48093-8091
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-9090
  • Fax: 586-573-2128
Mailing address:
  • Phone: 586-573-9090
  • Fax: 586-573-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTOUN OSKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-573-9090