Provider Demographics
NPI:1720562937
Name:HURON VALLEY HOUSE PEDS PLLC
Entity Type:Organization
Organization Name:HURON VALLEY HOUSE PEDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:SHABB
Authorized Official - Last Name:QALIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-220-3700
Mailing Address - Street 1:32406 FRANKLIN RD UNIT 250577
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-7022
Mailing Address - Country:US
Mailing Address - Phone:248-760-0899
Mailing Address - Fax:
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-5041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty