Provider Demographics
NPI:1376756239
Name:HIGHLAND PEDIATRICS
Entity Type:Organization
Organization Name:HIGHLAND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ARDESHIR
Authorized Official - Middle Name:
Authorized Official - Last Name:IRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-773-1823
Mailing Address - Street 1:208 W HIGHLAND RD
Mailing Address - Street 2:STE 100
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48357-4574
Mailing Address - Country:US
Mailing Address - Phone:248-889-9467
Mailing Address - Fax:586-773-1211
Practice Address - Street 1:208 W HIGHLAND RD
Practice Address - Street 2:STE 100
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48357-4574
Practice Address - Country:US
Practice Address - Phone:248-889-9467
Practice Address - Fax:586-773-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAI064238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38582550OtherTAX ID
MI4343844Medicaid
MI3506329012OtherBCBS
MI3506329012OtherBCBS