Provider Demographics
NPI:1215182787
Name:PEDIATRIC & ADULT HEALTH CARE PC
Entity Type:Organization
Organization Name:PEDIATRIC & ADULT HEALTH CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-575-4988
Mailing Address - Street 1:15255 NORTHLINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2487
Mailing Address - Country:US
Mailing Address - Phone:734-285-3090
Mailing Address - Fax:734-285-3095
Practice Address - Street 1:30260 CHERRY HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2676
Practice Address - Country:US
Practice Address - Phone:734-466-9000
Practice Address - Fax:734-466-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty