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VERNOR PEDIATRIC PC NPI 1073010625


NPI Information

NPI: 1073010625
Provider Name: VERNOR PEDIATRIC PC

Former Legal Business Name: KARMO PEDIATRIC CENTER

Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

CLIA Number: 23D2147657

Address:
4607 W VERNOR HWY
DETROIT, MI
ZIP 48209
Phone: (313) 554-3300
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VERNOR PEDIATRIC PC is an adolescent medicine pediatrics in Detroit, MI. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. VERNOR PEDIATRIC PC NPI is 1073010625. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Karmo Pediatric Center.

The provider's business location address is:

4607 W VERNOR HWY
DETROIT, MI
ZIP 48209-117
Phone: (313) 554-3300
Fax: (313) 554-3303

The provider's authorized official is Teresa Ball .
The authorized official title is Cpc and has the following contact phone number (734) 839-6610.

The CLIA number assigned to this NPI record is 23D2147657 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/10/2018 and was last updated on 6/10/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12080A0000XPediatricsAdolescent MedicineNK069655MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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