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General NPI Number Information
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NPI Number | 1962625947
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Entity Type | Organization
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Legal Business Name | GRAND BLANC PEDIATRICS
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8220 S SAGINAW ST SUITE 1000
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City | GRAND BLANC
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State | MI
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Zip | 48439-1890
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Country | US
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Telephone | 810-695-6565
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Fax | 810-695-9476
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Provider Business Mailing Address
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Address Line | 8220 S SAGINAW ST SUITE 1000
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City | GRAND BLANC
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State | MI
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Zip | 48439-1890
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Country | US
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Telephone | 810-695-6565
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Fax | 810-695-9476
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Authorized Official
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Title or Position | OWNER
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Name | FAWAZ HADDAD
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Credential | M.D.
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Telephone | 810-695-6565
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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 | FH063791
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License Number State | MI
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