Provider Demographics
NPI:1225219728
Name:MOMMY AND ME MATERNAL PAMPERING AND FETAL ASSESSMENT CENTER, LLC
Entity Type:Organization
Organization Name:MOMMY AND ME MATERNAL PAMPERING AND FETAL ASSESSMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANETTA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-598-7200
Mailing Address - Street 1:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48333-2660
Mailing Address - Country:US
Mailing Address - Phone:248-851-6667
Mailing Address - Fax:248-851-6668
Practice Address - Street 1:33026 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3634
Practice Address - Country:US
Practice Address - Phone:248-851-6667
Practice Address - Fax:248-851-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430060101261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty