Provider Demographics
NPI:1457443962
Name:PEDI CARE PEDIATRIC CLINIC PC
Entity Type:Organization
Organization Name:PEDI CARE PEDIATRIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:TURKISH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-427-3636
Mailing Address - Street 1:35240 NANKIN BLVD
Mailing Address - Street 2:BLVD 401
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-7218
Mailing Address - Country:US
Mailing Address - Phone:734-427-3636
Mailing Address - Fax:734-427-1483
Practice Address - Street 1:35240 NANKIN BLVD
Practice Address - Street 2:BLVD 401
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7218
Practice Address - Country:US
Practice Address - Phone:734-427-3636
Practice Address - Fax:734-427-1483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI=========OtherOFFICE TAXID