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General NPI Number Information
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NPI Number | 1124051990
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Entity Type | Organization
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Legal Business Name | SHELBY PEDIATRIC ASSOCIATES AND CHILD LUNG CENTER PC
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 15125 22 MILE RD
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-4406
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Country | US
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Telephone | 586-532-0599
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Fax | 586-566-8967
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Provider Business Mailing Address
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Address Line | 15125 22 MILE RD
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City | SHELBY TOWNSHIP
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State | MI
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Zip | 48315-4406
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Country | US
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Telephone | 586-532-0599
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Fax | 586-566-8967
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIA PELLERITO
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Credential |
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Telephone | 586-532-0599
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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 | AR2460549
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License Number State | MI
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