Provider Demographics
NPI:1306003538
Name:GREENWOOD PEDIATRICS
Entity Type:Organization
Organization Name:GREENWOOD PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASEER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMAYUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD38
Authorized Official - Phone:517-784-9104
Mailing Address - Street 1:720 W FRANKLIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1674
Mailing Address - Country:US
Mailing Address - Phone:517-784-9104
Mailing Address - Fax:517-784-9107
Practice Address - Street 1:720 W FRANKLIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1674
Practice Address - Country:US
Practice Address - Phone:517-784-9104
Practice Address - Fax:517-784-9107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINH033036208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102196OtherPREFERRED CHOICES
MI5192038OtherAETNA
MI8503811891OtherBLUE CARE NETORK
MI8503811891OtherBLUE CROSS BLUE SHIELD
MI1220021OtherPHP
MI900039729OtherPRIORITY HEALTH