Provider Demographics
NPI:1366562142
Name:WOODS PEDIATRICS CLINIC
Entity type:Organization
Organization Name:WOODS PEDIATRICS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-886-3232
Mailing Address - Street 1:19925 VERNIER RD
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1486
Mailing Address - Country:US
Mailing Address - Phone:313-886-3232
Mailing Address - Fax:313-886-1833
Practice Address - Street 1:19925 VERNIER RD
Practice Address - Street 2:
Practice Address - City:HARPER WOODS
Practice Address - State:MI
Practice Address - Zip Code:48225-1486
Practice Address - Country:US
Practice Address - Phone:313-886-3232
Practice Address - Fax:313-886-1833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2593409Medicaid
MI2593409Medicaid
08206757351Medicare ID - Type Unspecified