NPIMap

Organization Active NPI

Mykidzdoc LLC

  • Pediatrics Physician
  • Canton, MI
National Provider Identifier
1154745933
Registry record updated Mar 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301095767 Issued in MI
Legal business name
MYKIDZDOC LLC
Practice address
48558 Woodson Way
Canton, MI 48187-6675
Phone
(773) 263-8984
NPI assigned
Feb 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Osama Sheth
Title
M.D
Phone
(773) 263-8984

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 4301095767 MI Primary

Addresses

Primary practice location

48558 Woodson Way
Canton, MI 48187-6675

Mailing address

48558 Woodson Way
Canton, MI 48187-6675
Phone (773) 263-8984

Other identifiers 1

IdentifierTypeStateIssuer
4301095767MedicaidMI

Other names 1

  • MYKIDZDOC Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1154745933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48558 WOODSON WAY",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481876675",
            "telephone_number": "773-263-8984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48558 WOODSON WAY",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481876675",
            "telephone_number": "773-263-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYKIDZDOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-13",
        "last_updated": "2014-03-21",
        "status": "A",
        "authorized_official_last_name": "SHETH",
        "authorized_official_first_name": "OSAMA",
        "authorized_official_title_or_position": "M.D",
        "authorized_official_telephone_number": "773-263-8984"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301095767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4301095767",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MYKIDZDOC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.