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General NPI Number Information
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NPI Number | 1447217732
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Entity Type | Organization
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Legal Business Name | GENESEE PEDIATRICS PC
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 05/27/2020
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Provider Practice Location Address
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Address Line | G5119 W BRISTOL ROAD SUITE A
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City | FLINT
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State | MI
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Zip | 48507
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Country | US
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Telephone | 810-720-1510
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Fax | 810-720-1726
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Provider Business Mailing Address
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Address Line | G5119 W BRISTOL ROAD SUITE A
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City | FLINT
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State | MI
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Zip | 48507
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Country | US
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Telephone | 810-720-1510
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Fax | 810-720-1726
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. MANAR HAMMOUD
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Credential | M.D.
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Telephone | 810-720-1510
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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 | 4301067983
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License Number State | MI
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