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General NPI Number Information
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NPI Number | 1689012601
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND ADOLESCENT CARE ASSOCIATES, PC
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Dates
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Enumeration Date | 06/12/2013
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 43184 DEQUINDRE RD SUITE 208
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1709
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Country | US
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Telephone | 586-731-1500
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Fax | 586-731-1363
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Provider Business Mailing Address
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Address Line | 43184 DEQUINDRE RD SUITE 208
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1709
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Country | US
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Telephone | 586-731-1500
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Fax | 586-731-1363
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHOBANA SUNDARAM
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Credential | M.D.
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Telephone | 586-731-1500
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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 | 4301077847
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License Number State | MI
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