Provider Demographics
NPI:1720493364
Name:THE PEDIATRIC TEAM
Entity Type:Organization
Organization Name:THE PEDIATRIC TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-288-5437
Mailing Address - Street 1:909 W MAPLE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1000
Mailing Address - Country:US
Mailing Address - Phone:248-288-5437
Mailing Address - Fax:248-288-5449
Practice Address - Street 1:909 W MAPLE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1000
Practice Address - Country:US
Practice Address - Phone:248-288-5437
Practice Address - Fax:248-288-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB49087Medicare UPIN
MIH52588Medicare UPIN