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Organization
MY KIDS DOC-SOUTHFIELD
Active
Organization
MY KIDS DOC-SOUTHFIELD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAMELA BERRY MD (OWNER/PHYSICIAN)
(248) 358-2410
Entity
Organization
Contact information
Practice address
29255 NORTHWESTERN HWY, SUITE 100, SOUTHFIELD, MI 48034-1018
(248) 358-2410
(248) 358-2470
Mailing address
PO BOX 33321, DRAWER 117, DETROIT, MI 48232-5321
(248) 358-2410
(248) 358-2470
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
PB047877
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730187840
—
MI
01
—
350F300680
BCN GROUP
MI
Enumeration date
07/12/2005
Last updated
04/29/2009
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