Pediatric Staff PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

031683 Issued in MI

Legal business name

PEDIATRIC STAFF PLLC

Practice address

22341 W 8 Mile Rd
Detroit, MI 48219-1217

Phone

(313) 255-2209

Fax

(313) 255-0773

NPI assigned

Feb 13, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Anne-Mare Ice, M.D.

Title

President

Phone

(313) 255-2209

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922140912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22341 W 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482191217",
            "telephone_number": "313-255-2209",
            "fax_number": "313-255-0773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22341 W 8 MILE RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482191217",
            "telephone_number": "313-255-2209",
            "fax_number": "313-255-0773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC STAFF PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ICE",
        "authorized_official_first_name": "ANNE-MARE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-255-2209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "031683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1066910",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Peck
• Nathan Peck, DO
• Nithin S Peddireddy, MD
• Pediatric Anesthesia Associates, PC
• Pediatric Neurosurgery Group, P.C.
• Pedro S. Franco, M.D., PC
• Jessica Dianne Pedrys, MS, OTR/L
• Marcia Peeples
• Tracie Ann Peer, ANP-BC
• Peerless Home Health Care; LLC

• Specialist in Detroit, MI
• Providers in Detroit, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.