Provider Demographics
NPI:1457459190
Name:MY KIDS DOC NOVI PLLC
Entity Type:Organization
Organization Name:MY KIDS DOC NOVI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEMBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-347-8040
Mailing Address - Street 1:41935 W 12 MILE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3111
Mailing Address - Country:US
Mailing Address - Phone:248-347-8040
Mailing Address - Fax:248-305-6179
Practice Address - Street 1:41935 W 12 MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3111
Practice Address - Country:US
Practice Address - Phone:248-347-8040
Practice Address - Fax:248-305-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty