Provider Demographics
NPI:1609422716
Name:WESTLAND PEDIATRIC ASSOCIATES PLLC
Entity Type:Organization
Organization Name:WESTLAND PEDIATRIC ASSOCIATES PLLC
Other - Org Name:WESTLAND PEDIATRIC ASSOCIATES PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:AGOMUOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-326-6333
Mailing Address - Street 1:37660 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1924
Mailing Address - Country:US
Mailing Address - Phone:734-326-6333
Mailing Address - Fax:734-326-7105
Practice Address - Street 1:37660 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1924
Practice Address - Country:US
Practice Address - Phone:734-326-6333
Practice Address - Fax:734-326-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty