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General NPI Number Information
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NPI Number | 1962446567
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Entity Type | Organization
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Legal Business Name | PEDIATRIC HEALTHCARE
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 42141 MOUND RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-3144
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Country | US
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Telephone | 586-254-7593
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Fax | 586-254-7834
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Provider Business Mailing Address
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Address Line | 42141 MOUND RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-3144
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Country | US
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Telephone | 586-254-7593
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Fax | 586-254-7834
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANN M MULDOON
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Credential | CMA
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Telephone | 586-254-7593
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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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