My Kids Doc-Southfield

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

PB047877 Issued in MI

Legal business name

MY KIDS DOC-SOUTHFIELD

Practice address

29255 Northwestern Hwy
Suite 100
Southfield, MI 48034-1018

Phone

(248) 358-2410

Fax

(248) 358-2470

NPI assigned

Jul 12, 2005

Last updated

Apr 29, 2009By 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

Dr. Pamela Berry, MDNPI 1811995491

Title

Owner/Physician

Phone

(248) 358-2410

Specialties & licenses 1

Addresses

Other identifiers 3

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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.

• Pamela Berry, MD

  • Pediatrics Physician
  • Southfield, MI
  • NPI 1811995491
  NPD (past) Authorized official
• Adekunbi Abosede Adelakun, M.D.

  • Pediatrics Physician
  • Southfield, MI
  • NPI 1801240445

  Single Specialty

  NPD (past)
• Marie-Jeanne D Monde-Matthews, MD

  • Pediatrics Physician
  • Southfield, MI
  • NPI 1568460152
  NPD (past)
• Lashaaisha Moss, FNP-C

  • Family Nurse Practitioner
  • Southfield, MI
  • NPI 1780155242
  NPD (past)
• Sharon Lee Tice, MD

  • Pediatrics Physician
  • Southfield, MI
  • NPI 1831177526
  NPD (past)
• Crystal Banks Daniels, MD

  • Pediatrics Physician
  • Addison, IL
  • NPI 1962400556
  NPD (past)

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240963200000",
    "number": "1730187840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33321",
            "address_2": "DRAWER 117",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482325321",
            "telephone_number": "248-358-2410",
            "fax_number": "248-358-2470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29255 NORTHWESTERN HWY",
            "address_2": "SUITE 100",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341018",
            "telephone_number": "248-358-2410",
            "fax_number": "248-358-2470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY KIDS DOC-SOUTHFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2009-04-29",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "248-358-2410",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MI",
            "license": "PB047877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN GROUP",
            "identifier": "350F300680",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "350F300680",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730187840",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Delani Rae Mwathi, AGNP-C
• MWD Enterprises LLC (Homewatch CareGivers of Southfield)
• My Advocates LLC
• My City Home Help Services
• My Family Dental Novi PLLC
• My Place Afc
• My Visiting Physicians PC
• Hannah Myers
• Larissa Sophie Myers
• Stacy Myers

• Pediatric Adolescent Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Pediatric Adolescent Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.