Healthcare Provider Details

I. General information

NPI: 1043466386
Provider Name (Legal Business Name): HELPING HANDS PEDIATRIC & ADOLESCENT MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 N WALNUT ST
SOUTH BLOOMFIELD OH
43103-1018
US

IV. Provider business mailing address

5030 N WALNUT ST
SOUTH BLOOMFIELD OH
43103-1018
US

V. Phone/Fax

Practice location:
  • Phone: 740-983-0015
  • Fax: 740-986-4763
Mailing address:
  • Phone: 740-983-0015
  • Fax: 740-986-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN STEVENSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 740-983-0015