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
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