Provider Demographics
NPI:1477857365
Name:DETROIT INSTITUTE FOR CHILDREN
Entity Type:Organization
Organization Name:DETROIT INSTITUTE FOR CHILDREN
Other - Org Name:PEDIATRIC POTENTIALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-832-1100
Mailing Address - Street 1:19505 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1643
Mailing Address - Country:US
Mailing Address - Phone:586-445-8200
Mailing Address - Fax:586-445-8201
Practice Address - Street 1:19505 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1643
Practice Address - Country:US
Practice Address - Phone:586-445-8200
Practice Address - Fax:586-445-8201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DETROIT INSTITUTE FOR CHILDREN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-06
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty