PEDIATRIC CARE CORNER PC NPI 1508864687

NPI Information

NPI: 1508864687
Provider Name: PEDIATRIC CARE CORNER PC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 23D0953888

Address:
2300 HAGGERTY RD
SUITE 2110
W BLOOMFIELD, MI
ZIP 48323
Phone: (248) 926-1411
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PEDIATRIC CARE CORNER PC is an adolescent medicine pediatrics in W Bloomfield, MI. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. PEDIATRIC CARE CORNER PC NPI is 1508864687. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2300 HAGGERTY RD
SUITE 2110
W BLOOMFIELD, MI
ZIP 48323-184
Phone: (248) 926-1411
Fax: (248) 926-5338

The provider's authorized official is Constance Rowley .
The authorized official title is Owner/physician and has the following contact phone number (248) 926-1411.

The CLIA number assigned to this NPI record is 23D0953888 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/12/2005 and was last updated on 10/16/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	CR010295	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0N96030	MEDICARE PIN	MICHIGAN
2	350F375630	OTHER	MICHIGAN	BCBC BCN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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