Provider Demographics
NPI:1992838015
Name:UNIVERSAL PEDIATRICS PC
Entity Type:Organization
Organization Name:UNIVERSAL PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:ALLEATA
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-833-7266
Mailing Address - Street 1:4727 SAINT ANTOINE ST
Mailing Address - Street 2:SUITE # 212
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-1461
Mailing Address - Country:US
Mailing Address - Phone:313-833-7266
Mailing Address - Fax:313-833-7085
Practice Address - Street 1:4727 SAINT ANTOINE ST
Practice Address - Street 2:SUITE # 212
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1461
Practice Address - Country:US
Practice Address - Phone:313-833-7266
Practice Address - Fax:313-833-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4739807Medicaid
MI4739790Medicaid
MI4739790Medicaid
MI4739807Medicaid