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General NPI Number Information
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NPI Number | 1093159105
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Entity Type | Organization
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Legal Business Name | PEDIATRIC & ADOLESCENT ADVANCE CARE PLLC
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 1230 S LINDEN RD STE 3A
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City | FLINT
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State | MI
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Zip | 48532-3459
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Country | US
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Telephone | 810-410-4869
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Fax |
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Provider Business Mailing Address
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Address Line | 8143 S SAGINAW ST SUITE 2
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City | GRAND BLANC
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State | MI
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Zip | 48439-1825
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Country | US
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Telephone | 810-584-7689
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FAISAL M MAWRI
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Credential | M.D.
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Telephone | 810-877-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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