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General NPI Number Information
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NPI Number | 1184037640
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Entity Type | Organization
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Legal Business Name | SUNRISE PEDIATRICS PC
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 1481 S CENTER RD
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City | BURTON
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State | MI
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Zip | 48509-1726
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Country | US
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Telephone | 810-373-2261
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Fax |
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Provider Business Mailing Address
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Address Line | 1481 S CENTER RD
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City | BURTON
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State | MI
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Zip | 48509-1726
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Country | US
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Telephone | 810-373-2261
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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. OSAMA ELSABAGH
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Credential | M.D.
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Telephone | 989-992-9408
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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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