Provider Demographics
NPI:1962446567
Name:PEDIATRIC HEALTHCARE
Entity Type:Organization
Organization Name:PEDIATRIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULDOON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:586-254-7593
Mailing Address - Street 1:42141 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-3144
Mailing Address - Country:US
Mailing Address - Phone:586-254-7593
Mailing Address - Fax:586-254-7834
Practice Address - Street 1:42141 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3144
Practice Address - Country:US
Practice Address - Phone:586-254-7593
Practice Address - Fax:586-254-7834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty