Provider Demographics
NPI:1093069346
Name:COMMERCE PEDIATRIC ASSOCIATES P.C.
Entity Type:Organization
Organization Name:COMMERCE PEDIATRIC ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDIPTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-366-0101
Mailing Address - Street 1:2900 UNION LAKE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-3500
Mailing Address - Country:US
Mailing Address - Phone:248-366-0101
Mailing Address - Fax:248-366-0108
Practice Address - Street 1:2900 UNION LAKE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-3500
Practice Address - Country:US
Practice Address - Phone:248-366-0101
Practice Address - Fax:248-366-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty