Provider Demographics
NPI:1134291982
Name:PREMIERE PEDIATRICS, PC
Entity Type:Organization
Organization Name:PREMIERE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SHAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-625-9755
Mailing Address - Street 1:7210 N MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1575
Mailing Address - Country:US
Mailing Address - Phone:248-625-9755
Mailing Address - Fax:248-620-9334
Practice Address - Street 1:7210 N MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1575
Practice Address - Country:US
Practice Address - Phone:248-625-9755
Practice Address - Fax:248-620-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty