Dearborn Pediatric & Adolescent Medical Center, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

4301064108 Issued in MI

Legal business name

DEARBORN PEDIATRIC & ADOLESCENT MEDICAL CENTER, PC

Practice address

6620 Schaefer Rd
Dearborn, MI 48126-4502

Phone

(313) 582-3700

Fax

(313) 582-3301

NPI assigned

Jul 8, 2005

Last updated

Jan 5, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lobna R Elhasan-Fakih, M.D.

Title

President

Phone

(313) 582-3700

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marissa Marie Johnson, P.A.-C.

  • Medical Physician Assistant
  • Dearborn, MI
  • NPI 1396997862
  NPD (past)

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1427056068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6620 SCHAEFER RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264502",
            "telephone_number": "313-582-3700",
            "fax_number": "313-582-3301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6620 SCHAEFER RD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481264502",
            "telephone_number": "313-582-3700",
            "fax_number": "313-582-3301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEARBORN PEDIATRIC & ADOLESCENT MEDICAL CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "ELHASAN-FAKIH",
        "authorized_official_first_name": "LOBNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-582-3700",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "4301064108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3479230",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4713462",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dearborn Obstetrical and Gynecological Associates, P.C.
• Dearborn Oral & Maxillofacial Surgery Associates, P.C.
• Dearborn Orthopedics & Sports Medicine P.C.
• Dearborn Pain Specialists, PLC
• Dearborn Ped & Adol Med Center II PLLC
• Dearborn Physical Therapy LTD.
• Dearborn Podiatric Surgeons, P.C.
• Dearborn Primary Care, P.C.
• Dearborn Psychological Services
• Dearborn Rehabilitation Inc

• Primary Care Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Primary Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; 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.