Provider Demographics
NPI:1437254448
Name:PEDIATRIC CLINIC, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABIRAGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-725-2670
Mailing Address - Street 1:35054 23 MILE RD
Mailing Address - Street 2:101
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2019
Mailing Address - Country:US
Mailing Address - Phone:586-725-2670
Mailing Address - Fax:586-725-3347
Practice Address - Street 1:35054 23 MILE RD
Practice Address - Street 2:101
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047-2019
Practice Address - Country:US
Practice Address - Phone:586-725-2670
Practice Address - Fax:586-725-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty