Provider Demographics
NPI:1093159105
Name:PEDIATRIC & ADOLESCENT ADVANCE CARE PLLC
Entity Type:Organization
Organization Name:PEDIATRIC & ADOLESCENT ADVANCE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAWRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-877-4908
Mailing Address - Street 1:8143 S SAGINAW ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1825
Mailing Address - Country:US
Mailing Address - Phone:810-584-7689
Mailing Address - Fax:
Practice Address - Street 1:1230 S LINDEN RD STE 3A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3459
Practice Address - Country:US
Practice Address - Phone:810-410-4869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty