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General NPI Number Information
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NPI Number | 1417126715
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Entity Type | Organization
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Legal Business Name | GREAT LAKES PEDIATRICS
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 26000 HOOVER RD 103
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City | WARREN
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State | MI
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Zip | 48089-1167
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Country | US
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Telephone | 586-427-1351
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Fax |
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Provider Business Mailing Address
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Address Line | 26000 HOOVER RD 103
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City | WARREN
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State | MI
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Zip | 48089-1167
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Country | US
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Telephone | 586-427-1351
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUNDUS RUMMANI-ASKAR
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Credential | M.D.
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Telephone | 586-427-1351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 4301073962
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License Number State | MI
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