Provider Demographics
NPI:1124265335
Name:UNIVERSITY PEDIATRICIANS
Entity type:Organization
Organization Name:UNIVERSITY PEDIATRICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER SERVICES REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-966-5051
Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:UNIVERSITY HEALTH CENTER 6F MAILBOX #226
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-6618
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-966-5051
Practice Address - Fax:313-966-6618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2022-12-08
Deactivation Date:2022-10-25
Deactivation Code:
Reactivation Date:2022-12-08
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty