Healthcare Provider Details

I. General information

NPI: 1699285023
Provider Name (Legal Business Name): CAMPGROUND PEDIATRICS WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60005 CAMPGROUND RD
WASHINGTON TOWNSHIP MI
48094-3445
US

IV. Provider business mailing address

51474 ORO DR
SHELBY TOWNSHIP MI
48315-2931
US

V. Phone/Fax

Practice location:
  • Phone: 586-991-7683
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CINZIA FILIPOVSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 586-212-3113