Organization
PEDIATRIC STAFF PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNE-MARE ICE M.D. (PRESIDENT)
(313) 255-2209
Entity
Organization
Contact information
Practice address
22341 W 8 MILE RD, DETROIT, MI 48219-1217
(313) 255-2209
(313) 255-0773
Mailing address
22341 W 8 MILE RD, DETROIT, MI 48219-1217
(313) 255-2209
(313) 255-0773
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
031683
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1066910
—
MI
Enumeration date
02/13/2007
Last updated
08/22/2020
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