Provider Demographics
NPI:1508065905
Name:DUNDEE PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:DUNDEE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-823-5437
Mailing Address - Street 1:120 WATERSTRADT-COMMERCE DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131
Mailing Address - Country:US
Mailing Address - Phone:734-823-5437
Mailing Address - Fax:734-240-3326
Practice Address - Street 1:120 WATERSTRADT-COMMERCE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131
Practice Address - Country:US
Practice Address - Phone:734-823-5437
Practice Address - Fax:734-240-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care