Healthcare Provider Details

I. General information

NPI: 1457443962
Provider Name (Legal Business Name): PEDI CARE PEDIATRIC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35240 NANKIN BLVD BLVD 401
WESTLAND MI
48185-7218
US

IV. Provider business mailing address

35240 NANKIN BLVD BLVD 401
WESTLAND MI
48185-7218
US

V. Phone/Fax

Practice location:
  • Phone: 734-427-3636
  • Fax: 734-427-1483
Mailing address:
  • Phone: 734-427-3636
  • Fax: 734-427-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101006757
License Number StateMI

VIII. Authorized Official

Name: VERNA JEAN TURKISH
Title or Position: OWNER
Credential: DO
Phone: 734-427-3636