1194892612 NPI number — CARE PEDIATRICS PLLC

Table of content: (NPI 1194892612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194892612 NPI number — CARE PEDIATRICS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE PEDIATRICS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194892612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1022 N TELEGRAPH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48128-1622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-274-6666
Provider Business Mailing Address Fax Number:
313-274-4466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48128-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-274-6666
Provider Business Practice Location Address Fax Number:
313-274-4466
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELSABBAGH
Authorized Official First Name:
ALEX
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
313-274-6666

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301080518 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 786-1 . This is a "THC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1427056068 . This is a "PHCS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 151159 . This is a "GREAT LAKES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 8206102 . This is a "BCN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3508206102 . This is a "BCBS GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 489769110 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6U4930 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 12965 . This is a "CAPE MEDICAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6U4930 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2409638 . This is a "OHS CARE NGS PED" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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