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Organization

BLOOMFIELD HILLS PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FIDELINA NITURA BARACEROS MD (OWNER)
(248) 334-6000
Entity
Organization

Contact information

Practice address
43750 WOODWARD AVE, STE 104, BLOOMFIELD HILLS, MI 48302-5063
(248) 334-6000
(248) 334-8740
Mailing address
43750 WOODWARD AVE, STE 104, BLOOMFIELD HILLS, MI 48302-5063
(248) 334-6000
(248) 334-8740

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
FB035468
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
101152
MERCY HEALTH PLAN ID
01
3506341231
BCBS PROVID ID #
01
FB035468
STATE LICENSURE NUMBER
MI
Enumeration date
04/02/2007
Last updated
08/22/2020
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