Organization
DEARBORN PEDIATRIC & ADOLESCENT MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOBNA R ELHASAN-FAKIH M.D. (PRESIDENT)
(313) 582-3700
Entity
Organization
Contact information
Practice address
6620 SCHAEFER RD, DEARBORN, MI 48126-4502
(313) 582-3700
(313) 582-3301
Mailing address
6620 SCHAEFER RD, DEARBORN, MI 48126-4502
(313) 582-3700
(313) 582-3301
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
4301064108
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3479230
—
MI
05
—
4713462
—
MI
Enumeration date
07/08/2005
Last updated
01/05/2011
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