GREAT LAKES PEDIATRICS – NPI #1417126715
Pediatrics

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.

Health Care Provider Taxonomy Code for Pediatrics

GREAT LAKES PEDIATRICS is a provider located in WARREN, MI. NPPES has assigned the NPI number 1417126715 to GREAT LAKES PEDIATRICS on February 21, 2008. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 2080A0000X from the Health Care Provider Taxonomy code set, which is classified as Pediatrics, specializing in Adolescent Medicine

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for GREAT LAKES PEDIATRICS below.

NPI Profile for
GREAT LAKES PEDIATRICS

NPI Number
1417126715
Enumeration Date

(more than 18 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
GREAT LAKES PEDIATRICS
Primary location
26000 HOOVER RD
103
WARREN, MI 48089-1167
Phone: (586) 427-1351 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
SUNDUS RUMMANI-ASKAR
PRESIDENT
Phone: (586) 427-1351
Updated
Identifiers

Identifiers for GREAT LAKES PEDIATRICS

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMI4435267
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2080A0000X
- Pediatrics / Adolescent Medicine (Primary)		 MI 4301073962

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.