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General NPI Number Information
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NPI Number | 1972765501
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Entity Type | Organization
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Legal Business Name | HILLSDALE PEDIATRIC CLINIC PC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 3755 15 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-5358
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Country | US
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Telephone | 586-722-7498
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Fax | 586-722-7499
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Provider Business Mailing Address
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Address Line | 3755 15 MILE RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-5358
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Country | US
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Telephone | 586-722-7498
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Fax | 586-722-7499
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL SACKMAN
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Credential | M.D.
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Telephone | 586-722-7498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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