Provider Demographics
NPI:1518185826
Name:RIVER OAKS PEDIATRICS
Entity Type:Organization
Organization Name:RIVER OAKS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NAZEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALHUSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-336-4444
Mailing Address - Street 1:20211 ANN ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-2691
Mailing Address - Country:US
Mailing Address - Phone:313-336-4444
Mailing Address - Fax:313-336-2355
Practice Address - Street 1:20211 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2691
Practice Address - Country:US
Practice Address - Phone:313-336-4444
Practice Address - Fax:313-336-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0556672080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P42750001Medicare PIN