Provider Demographics
NPI:1245453125
Name:MACOMB PEDIATRIC ASSOCIATEA P.C
Entity type:Organization
Organization Name:MACOMB PEDIATRIC ASSOCIATEA P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-573-9090
Mailing Address - Street 1:29703 HOOVER
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-8091
Mailing Address - Country:US
Mailing Address - Phone:586-573-9090
Mailing Address - Fax:586-573-2128
Practice Address - Street 1:29703 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-8901
Practice Address - Country:US
Practice Address - Phone:586-573-9090
Practice Address - Fax:586-573-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty