Detroit Institute for Children

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

DETROIT INSTITUTE FOR CHILDREN

Doing business as

Pediatric Potentials

Practice address

19505 E 8 Mile Rd
Saint Clair Shores, MI 48080-1643

Phone

(586) 445-8200

Fax

(586) 445-8201

NPI assigned

Jan 6, 2011

Last updated

Apr 4, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

THE DETROIT INSTITUTE FOR CHILDRENAs reported in NPPES

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

Authorized official

Name

Mr. Mark Cleary

Title

President/Ceo

Phone

(313) 832-1100

Specialties & licenses 2

Addresses

Other names 1

• Pediatric Potentials Doing business as

Part of

Detroit Institute Children

Locations

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

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1477857365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19505 E 8 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801643",
            "telephone_number": "586-445-8200",
            "fax_number": "586-445-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19505 E 8 MILE RD",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801643",
            "telephone_number": "586-445-8200",
            "fax_number": "586-445-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT INSTITUTE FOR CHILDREN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE DETROIT INSTITUTE FOR CHILDREN",
        "enumeration_date": "2011-01-06",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "CLEARY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "313-832-1100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Potentials",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberley Demerle, M.D.
• Michael R. Demers, M.D.
• Joanne Denison, ACSW
• Gabrielle Aimee Deschaine, LPC
• Carline Desir
• Susan E. Dettloff, LMSW
• Katie Dewitt, DPT
• Karamvir Kaur Dhillon, M.D
• Diabetic Supply Center
• Diana Whittaker DDS PLC (Smiles on Little Mack)

• Specialist in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; 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.