GREAT LAKES PEDIATRICS (NPI# 1417126715) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417126715 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES PEDIATRICS |
| Practice Address |
26000 Hoover Rd 103 Warren MI 48089-1167 |
| Practice Telephone | 5864271351 |
| Mailing Telephone | 5864271351 |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2008-02-21 |
| Authorized Official Name | DR. SUNDUS RUMMANI-ASKAR (PRESIDENT) |
| Authorized Official Telephone | 5864271351 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
4301073962 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 4435267 | 05 |
| Street Address |
26000 HOOVER RD 103 |
| City | WARREN |
| State | MI |
| Zip Code | 48089-1167 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386777324 | Stasio Chiropractic Center P.C. | Chiropractor | 26000 Hoover Rd, Suite 110 Stasio Chiropractic Center, Warren, MI 48089 | 2007-03-13 |
| 1912512575 | Park Warren Physical Therapy LLC | Clinic/Center | 26000 Hoover Rd, Warren, MI 48089-1167 | 2020-09-10 |
| 1477109528 | Premier Medical Movement Management Company LLC | Clinic/Center | 26000 Hoover Rd, Warren, MI 48089-1167 | 2019-08-14 |
| 1760034532 | Heba Habib Shathaya | Physician Assistant | 26000 Hoover Rd, Warren, MI 48089-1167 | 2019-07-11 |
| 1225695232 | Kelsey Anne Macconnachie | Physician Assistant | 26000 Hoover Rd, Warren, MI 48089-1167 | 2019-05-24 |
| 1245758739 | Haley Hani Matty | Physician Assistant | 26000 Hoover Rd, Warren, MI 48089 | 2017-09-05 |
| 1558882241 | Randy Neil Marvin Levesque | Nurse Practitioner | 26000 Hoover Rd, Warren, MI 48089-1167 | 2017-07-03 |
| 1245695287 | Mariam Aziz | Physician Assistant | 26000 Hoover Rd, Warren, MI 48089-1167 | 2015-12-17 |
| 1578967881 | Hoover Family Dental Pllc | Clinic/Center | 26000 Hoover Rd, Suite # 102, Warren, MI 48089 | 2014-10-15 |
| 1265874150 | Warren Family Medical Center Pllc | Family Medicine | 26000 Hoover Rd, 100, Warren, MI 48089-1167 | 2013-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477184414 | Delaine Armstong | Pharmacist | 13488 E. 11 Mile Road, Warren, MI 48089 | 2020-01-29 |
| 1679118236 | Good N Plenty Rx LLC | Pharmacy | 22260 Van Dyke Avenue, Warren, MI 48089 | 2019-11-07 |
| 1508367111 | Meijer, Inc. | Durable Medical Equipment & Medical Supplies | 25225 Schoenherr Rd, Warren, MI 48089 | 2018-02-28 |
| 1932624970 | Jessica D Johnston | Social Worker | 11415 Metter Ave, Warren, MI 48089 | 2017-08-10 |
| 1508222944 | Dinas Kamaitis | Non-emergency Medical Transport (VAN) | 14560 E 10 Mile, 13993 10 Mile, Warren, MI 48089 | 2016-01-14 |
| 1770837296 | Michigan Home Exteriors | Durable Medical Equipment & Medical Supplies | 11444 Kaltz Ave, Warren, MI 48089 | 2012-11-06 |
| 1407100142 | Brenda Tringali | Social Worker | 12220 E 13 Mile, Warren, MI 48089 | 2012-11-02 |
| 1154606838 | Binary Therapy Alliance,inc | Home Health | 26105 Regency Club Lane, 8, Warren, MI 48089 | 2011-10-13 |
| 1396920443 | Ron Zachariah | Physical Therapist | Horizon Medical Building, 13251 E Ten Mile Road Suite 400, Warren, MI 48089 | 2008-01-08 |
| 1053500173 | Anemaecore Abadejos Brodith | Physical Therapist | 26000 Hoover Rd Ste 101, Warren, MI 48089 | 2007-10-15 |
| Find all providers in zip 48089 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801257738 | Alshefa Family Practice Pllc | Pediatrics | 28780 Ryan Rd, Suite B, Warren, MI 48092-2521 | 2016-03-20 |
| 1528017555 | Husain Arastu | Pediatrics | 28771 Hoover Rd, Warren, MI 48093-4152 | 2006-05-08 |
| 1093777369 | Parvin P Shaibani | Pediatrics | 1032 E Market St, Warren, OH 44483-6602 | 2006-04-04 |
| 1821369422 | Warren Pediatric Associates | Pediatrics | 34 Mountain Blvd, Bldg A Suite 130, Warren, NJ 07059-2640 | 2012-01-13 |
| 1881758365 | Sarah Rachel Berg Kramer | Pediatrics | 76 Stirling Rd, Suite 201, Warren, NJ 07059-5778 | 2006-12-20 |
| 1619088945 | Andrea G Ploshnick | Pediatrics | 76 Stirling Road, Suite 201, Warren, NJ 07059-5778 | 2006-08-31 |
| 1083637896 | Lin-lan Tang | Pediatrics | 27 Mountain Blvd, Suite 2, Warren, NJ 07059-5605 | 2006-07-25 |
| 1518912013 | Antoun Oska | Pediatrics | 29703 Hoover Rd, Warren, MI 48093-8901 | 2006-05-23 |
| 1225083967 | Ashraf H Berry | Pediatrics | 29703 Hoover Rd, Warren, MI 48093-8901 | 2006-05-23 |
| 1588619126 | Mun Kyom Kim | Pediatrics | 29703 Hoover Rd, Warren, MI 48093-8901 | 2006-05-23 |
| Find all providers in WARREN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.