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General NPI Number Information
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NPI Number | 1467782805
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Entity Type | Organization
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Legal Business Name | PRIME PEDIATRICS AND ADOLESCENTS
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Dates
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Enumeration Date | 01/07/2010
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 1335 S LINDEN RD STE A
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City | FLINT
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State | MI
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Zip | 48532-3420
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Country | US
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Telephone | 248-686-4092
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Fax |
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Provider Business Mailing Address
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Address Line | 6416 SOUTHPOINTE DR
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City | TROY
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State | MI
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Zip | 48085-1007
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Country | US
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Telephone | 248-686-4092
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. NUZHAT ALI
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Credential | MD
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Telephone | 248-145-3478
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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 |
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License Number State |
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