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MAIN STREET PEDIATRICS PLLC NPI 1073853008


NPI Information

NPI: 1073853008
Provider Name: MAIN STREET PEDIATRICS PLLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 23D2247975

Address:
7362 RAFFORD LN
WEST BLOOMFIELD, MI
ZIP 48322
Phone: (248) 819-2664
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MAIN STREET PEDIATRICS PLLC is a pediatrics in West Bloomfield, MI. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. MAIN STREET PEDIATRICS PLLC NPI is 1073853008. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

7362 RAFFORD LN
WEST BLOOMFIELD, MI
ZIP 48322-190
Phone: (248) 819-2664

The provider's authorized official is Rhonda Yono-atisha .
The authorized official title is Managing Member and has the following contact phone number (248) 819-2664.

The CLIA number assigned to this NPI record is 23D2247975 - independent with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/28/2013 and was last updated on 2/28/2013.


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
1208000000XPediatrics4301088451MICHIGANYes

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: 11/14/2023

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