Provider Demographics
NPI:1801992698
Name:MEDICAL CENTER PEDIATRICS PLLC
Entity type:Organization
Organization Name:MEDICAL CENTER PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-642-5437
Mailing Address - Street 1:30400 TELEGRAPH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025
Mailing Address - Country:US
Mailing Address - Phone:248-642-5437
Mailing Address - Fax:248-642-5456
Practice Address - Street 1:30400 TELEGRAPH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025
Practice Address - Country:US
Practice Address - Phone:248-642-5437
Practice Address - Fax:248-642-5456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350F317240OtherBCBS M