Provider Demographics
NPI:1033257506
Name:BRIGHTON PEDIATRIC CENTER PLLC
Entity Type:Organization
Organization Name:BRIGHTON PEDIATRIC CENTER PLLC
Other - Org Name:BRIGHTON PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:SHABB
Authorized Official - Last Name:QALIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-220-3700
Mailing Address - Street 1:8550 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4352
Mailing Address - Country:US
Mailing Address - Phone:810-220-3700
Mailing Address - Fax:810-220-1321
Practice Address - Street 1:8550 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4352
Practice Address - Country:US
Practice Address - Phone:810-220-3700
Practice Address - Fax:810-220-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty