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General NPI Number Information
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NPI Number | 1871660324
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Entity Type | Organization
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Legal Business Name | WEST BLOOMFIELD PEDIATRICS PLLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 11/24/2023
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Provider Practice Location Address
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Address Line | 46325 W 12 MILE RD
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City | NOVI
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State | MI
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Zip | 48377-2456
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Country | US
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Telephone | 248-596-1000
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Fax | 248-230-5482
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Provider Business Mailing Address
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Address Line | 46325 W 12 MILE RD STE 240
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City | NOVI
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State | MI
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Zip | 48377-2462
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Country | US
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Telephone | 248-596-1000
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Fax | 248-305-8250
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SETH H FORMAN
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Credential | MD
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Telephone | 248-596-1000
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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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