Provider Demographics
NPI:1093005613
Name:KID KARE PEDIATRICS, PC
Entity Type:Organization
Organization Name:KID KARE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAISSAM
Authorized Official - Middle Name:GHALEB
Authorized Official - Last Name:EL-TAKECH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-752-8987
Mailing Address - Street 1:6636 N. TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127
Mailing Address - Country:US
Mailing Address - Phone:313-274-3123
Mailing Address - Fax:313-274-3343
Practice Address - Street 1:6636 N. TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127
Practice Address - Country:US
Practice Address - Phone:313-274-3123
Practice Address - Fax:313-274-3343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KID KARE PEDIATRICS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-16
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200082190AMedicaid