Organization
CHILD AND ADOLESCENT CENTER P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA GREEN (OFFICE MANAGER)
(734) 283-4616
Entity
Organization
Contact information
Practice address
15350 TRENTON RD, SOUTHGATE, MI 48195-2027
(734) 283-4616
(734) 283-5430
Mailing address
15350 TRENTON RD, SOUTHGATE, MI 48195-2027
(734) 283-4616
(734) 283-5430
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
350H27736
BCBSM PROVIDER ID NUMBER
MI
Enumeration date
10/10/2006
Last updated
12/13/2011
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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