Provider Demographics
NPI:1457796971
Name:CAMPBELL PEDIATRICS
Entity Type:Organization
Organization Name:CAMPBELL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RASHED
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-417-3890
Mailing Address - Street 1:PO BOX 99148
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-9148
Mailing Address - Country:US
Mailing Address - Phone:810-233-7103
Mailing Address - Fax:810-233-9710
Practice Address - Street 1:1010 N CAMPBELL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1570
Practice Address - Country:US
Practice Address - Phone:248-629-9146
Practice Address - Fax:810-233-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054627208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty