Organization
PEDIATRIC CLINIC ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY ALONZI DO (DOCTOR)
(734) 459-9260
Entity
Organization
Contact information
Practice address
9365 N HAGGERTY RD, PLYMOUTH, MI 48170-4622
(734) 459-9260
(734) 459-0612
Mailing address
9365 N HAGGERTY RD, PLYMOUTH, MI 48170-4622
(734) 459-9260
(734) 459-0612
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1345362
—
MI
01
—
3558200335
BLUE CROSS BLUE SHIELD
—
Enumeration date
05/27/2008
Last updated
11/02/2012
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