Provider Demographics
NPI:1912052010
Name:CHILD AND ADULT MEDICINE OF GRAND BLANC
Entity Type:Organization
Organization Name:CHILD AND ADULT MEDICINE OF GRAND BLANC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HABIB
Authorized Official - Middle Name:KHALID
Authorized Official - Last Name:AKRAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-694-9110
Mailing Address - Street 1:8235 HOLLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2441
Mailing Address - Country:US
Mailing Address - Phone:810-694-9110
Mailing Address - Fax:
Practice Address - Street 1:8235 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2441
Practice Address - Country:US
Practice Address - Phone:810-694-9110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067790208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH03398Medicare UPIN