Davison Pediatrics PC
Organization Active NPI Pediatrics Physician · Davison, MI
NPI 1609165646 · NPPES record last updated Mar 30, 2011
Key facts
- NPI
- 1609165646
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 4301063221 (MI)
- Legal business name
- DAVISON PEDIATRICS PC
- Practice address
- 1260 N Irish Rd
Ste a
Davison, MI 48423-2276 - Phone
- (810) 658-9550
- Fax
- (810) 658-2202
- NPI assigned
- Mar 30, 2011
- Organization subpart
- No
Authorized official
- Name
- Kamal Hasan, MD
- Title
- Owner
- Phone
- (810) 658-9550
Practitioners 1
-
Kamal S Hasan, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0901391 | Davison Pediatrics | Certificate of waiver | May 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110708000159 | MI | Part B Supplier - Clinic/Group Practice | 7517145816 |
Receives reassigned benefits from 1 practitioner Practice locations: Davison, MI; Flint, MI; Grand Blanc, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | 4301063221 | MI | Yes |
Addresses
Primary practice location
1260 N Irish Rd
Ste a
Davison, MI 48423-2276
Mailing address
1260 N Irish Rd
Ste a
Davison, MI 48423-2276
Phone (810) 658-9550
Other providers in Davison, MI
- Debra Davis
- Davison Drug Store Inc
- Davison Family Dentistry
- Davison Family Dentistry, P.C.
- Davison Medical Practice PLC
- Davison Pharmacy LLC
- Davison Physical Therapy Specialists, LLC
- Davison Urgent Care PC
- Davison Vision Center LLC
- Scott Delange
All providers in Davison, MI · Pediatrics Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.