Provider Demographics
NPI:1922343458
Name:HARTLAND PEDIATRICS
Entity Type:Organization
Organization Name:HARTLAND PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:EYO
Authorized Official - Last Name:INYANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-207-5780
Mailing Address - Street 1:11525 HIGHLAND RD STE 14
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48353-2726
Mailing Address - Country:US
Mailing Address - Phone:810-632-3200
Mailing Address - Fax:810-632-3230
Practice Address - Street 1:11525 HIGHLAND RD STE 14
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353-2726
Practice Address - Country:US
Practice Address - Phone:810-632-3200
Practice Address - Fax:810-632-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI04781F261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care