Provider Demographics
NPI:1023197357
Name:PEDIATRIC SPECIALISTS OF BLOOMFIELD HILLS,P.C
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALISTS OF BLOOMFIELD HILLS,P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-454-9000
Mailing Address - Street 1:43097 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5041
Mailing Address - Country:US
Mailing Address - Phone:248-454-9000
Mailing Address - Fax:248-454-9100
Practice Address - Street 1:43097 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5041
Practice Address - Country:US
Practice Address - Phone:248-454-9000
Practice Address - Fax:248-454-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074881208000000X
MI4301067190208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH90854Medicare UPIN
MIF77536Medicare UPIN