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General NPI Number Information
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NPI Number | 1609422716
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Entity Type | Organization
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Legal Business Name | WESTLAND PEDIATRIC ASSOCIATES PLLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 37660 FORD RD
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City | WESTLAND
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State | MI
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Zip | 48185-1924
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Country | US
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Telephone | 734-326-6333
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Fax | 734-326-7105
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Provider Business Mailing Address
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Address Line | 37660 FORD RD
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City | WESTLAND
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State | MI
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Zip | 48185-1924
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Country | US
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Telephone | 734-326-6333
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Fax | 734-326-7105
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Authorized Official
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Title or Position | MANAGER
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Name | DR. BRIDGET CHINYERE AGOMUOH
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Credential |
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Telephone | 734-326-6333
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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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