Provider Demographics
NPI:1821130980
Name:GENESEE PEDIATRICS
Entity Type:Organization
Organization Name:GENESEE PEDIATRICS
Other - Org Name:MANAR HAMMOUD, M.D., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-720-1510
Mailing Address - Street 1:5067 W BRISTOL RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2924
Mailing Address - Country:US
Mailing Address - Phone:810-720-1510
Mailing Address - Fax:810-720-1726
Practice Address - Street 1:5067 W BRISTOL RD
Practice Address - Street 2:SUITE J
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2924
Practice Address - Country:US
Practice Address - Phone:810-720-1510
Practice Address - Fax:810-720-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067983208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3502505342OtherBLUE CROSS BLUE SHIELD
MI0988606OtherHEALTH PLUS
MI3502505342OtherBLUE CROSS BLUE SHIELD