Provider Demographics
NPI:1265623276
Name:LAPEER PEDIATRICS, P.C.
Entity type:Organization
Organization Name:LAPEER PEDIATRICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL HARASTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-245-9700
Mailing Address - Street 1:1083 SUNCREST DR
Mailing Address - Street 2:SUITE-A
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4421
Mailing Address - Country:US
Mailing Address - Phone:810-245-9700
Mailing Address - Fax:810-245-9703
Practice Address - Street 1:1083 SUNCREST DR
Practice Address - Street 2:SUITE-A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4421
Practice Address - Country:US
Practice Address - Phone:810-245-9700
Practice Address - Fax:810-245-9703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067273261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350D410030OtherBLUE CARE NETWORK
MI526OtherPPOM
MI1026494OtherMCLAREN HEALTH PLAN
MI41A87114OtherHEALTH PLUS
MI8572330001OtherCIGNA
MIF76263OtherHEALTH ALLIANCE PLAN
0P48210OtherMEDICARE PTAN NUMBER
MI35-0-44-1237-1OtherBCBS
MI1026494OtherMCLAREN HEALTH ADVANTAGE
MI1619968922Medicaid
MI5243111OtherAETNA