Healthcare Provider Details

I. General information

NPI: 1730124934
Provider Name (Legal Business Name): NORTHPOINTE PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30061 SCHOENHERR RD STE A
WARREN MI
48088-3133
US

IV. Provider business mailing address

30061 SCHOENHERR RD STE A
WARREN MI
48088-3133
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-2111
  • Fax: 586-558-2169
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberBE055927
License Number StateMI

VIII. Authorized Official

Name: KAY ASPENLEITER
Title or Position: OFFICE MANAGER
Credential:
Phone: 586-558-2111