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General NPI Number Information
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NPI Number | 1124265335
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Entity Type | Organization
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Legal Business Name | UNIVERSITY PEDIATRICIANS
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-966-5051
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Fax | 313-966-6618
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Provider Business Mailing Address
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Address Line | 4201 SAINT ANTOINE ST UNIVERSITY HEALTH CENTER 6F MAILBOX #226
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-966-5051
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Fax | 313-966-6618
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Authorized Official
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Title or Position | PROVIDER SERVICES REPRESENTATIVE
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Name | MS. YOLANDA BROWN
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Credential |
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Telephone | 313-966-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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