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General NPI Number Information
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NPI Number | 1235506908
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Entity Type | Organization
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Legal Business Name | DEXTER PEDIATRICS LLC
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 12632 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48238-3340
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Country | US
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Telephone | 586-776-4185
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Fax |
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Provider Business Mailing Address
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Address Line | 12632 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48238-3340
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Country | US
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Telephone | 586-776-4185
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. SATISH RAVILAL MEHTA
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Credential | MD
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Telephone | 313-378-4620
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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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