MY KIDS DOC-SOUTHFIELD NPI 1730187840

NPI Information

MY KIDS DOC-SOUTHFIELD is an adolescent medicine pediatrics in Southfield, 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. MY KIDS DOC-SOUTHFIELD NPI is 1730187840. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

29255 NORTHWESTERN HWY
SUITE 100
SOUTHFIELD, MI
ZIP 48034-018
Phone: (248) 358-2410
Fax: (248) 358-2470

The provider's authorized official is Pamela Berry .
The authorized official title is Owner/physician and has the following contact phone number (248) 358-2410.

The CLIA number assigned to this NPI record is 23D1010247 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/12/2005 and was last updated on 4/29/2009.

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:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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