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General NPI Number Information
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NPI Number | 1700519444
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Entity Type | Organization
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Legal Business Name | ICARE PEDIATRICS
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Dates
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Enumeration Date | 07/08/2022
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 2390 WOODLAKE DR STE 380A
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City | OKEMOS
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State | MI
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Zip | 48864-6017
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Country | US
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Telephone | 517-775-8240
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Fax |
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Provider Business Mailing Address
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Address Line | 3598 CABARET TRL
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City | OKEMOS
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State | MI
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Zip | 48864-4082
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FAREEHA NAZ
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Credential | MD
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Telephone | 517-775-8240
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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 |
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License Number State |
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