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General NPI Number Information
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NPI Number | 1033408935
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Entity Type | Organization
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Legal Business Name | HAMTRAMCK PEDIATRICS
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 12033 CONANT ROAD
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City | HAMTRAMCK
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State | MI
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Zip | 48212
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Country | US
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Telephone | 313-366-4000
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Fax | 313-366-4001
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Provider Business Mailing Address
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Address Line | 12033 CONANT ROAD
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City | HAMTRAMCK
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State | MI
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Zip | 48212
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Country | US
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Telephone | 313-366-4000
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Fax | 313-366-4001
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | MONIRUZZAMAN KHAN
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Credential | M.D
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Telephone | 313-366-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301057394
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License Number State | MI
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