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General NPI Number Information
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NPI Number | 1992919203
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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 | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6400 FARMINGTON ROAD SUITE TEN
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City | W BLOOMFIELD
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State | MI
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Zip | 48322
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Country | US
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Telephone | 248-788-1200
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Fax | 248-788-2346
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Provider Business Mailing Address
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Address Line | 46325 WEST TWELVE MILE ROAD SUITE 240
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City | NOVI
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State | MI
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Zip | 48377
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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. STEVEN B GLICKFIELD
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Credential | DO
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Telephone | 248-788-1200
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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 | 4301086791
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License Number State | MI
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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 | 4301076640
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5101006183
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4301068662
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License Number State | MI
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