Provider Demographics
NPI:1336856335
Name:ENCORE PEDIATRICS, LLC
Entity Type:Organization
Organization Name:ENCORE PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP OF PEDIATRICS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-672-2593
Mailing Address - Street 1:33533 W 12 MILE RD STE 290
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5635
Mailing Address - Country:US
Mailing Address - Phone:866-925-8505
Mailing Address - Fax:
Practice Address - Street 1:33533 W 12 MILE RD STE 290
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-5635
Practice Address - Country:US
Practice Address - Phone:866-925-8505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty