Provider Demographics
NPI:1558518613
Name:SG PEDIATRICS OF LAKE ORION
Entity Type:Organization
Organization Name:SG PEDIATRICS OF LAKE ORION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SWARAJYALAXMI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-638-3385
Mailing Address - Street 1:1455 S LAPEER RD STE 134
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1468
Mailing Address - Country:US
Mailing Address - Phone:248-683-3385
Mailing Address - Fax:248-683-8441
Practice Address - Street 1:1455 S LAPEER RD STE 134
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1468
Practice Address - Country:US
Practice Address - Phone:248-683-3385
Practice Address - Fax:248-683-8441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty