Provider Demographics
NPI:1477943900
Name:PEDIATRIC & ADOLESCENT CLINIC OF MICHIGAN
Entity Type:Organization
Organization Name:PEDIATRIC & ADOLESCENT CLINIC OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:LORETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-859-9799
Mailing Address - Street 1:37375 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4090
Mailing Address - Country:US
Mailing Address - Phone:313-859-9799
Mailing Address - Fax:
Practice Address - Street 1:37375 CURTIS RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4090
Practice Address - Country:US
Practice Address - Phone:313-859-9799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty