Organization Active NPI

Pediatric Healthcare

  • Pediatric Adolescent Medicine Physician
  • Sterling Heights, MI
National Provider Identifier
1962446567
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
PEDIATRIC HEALTHCARE
Practice address
42141 Mound Rd
Sterling Heights, MI 48314-3144
Phone
(586) 254-7593
Fax
(586) 254-7834
NPI assigned
Jun 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ann M Muldoon, CMA
Title
Office Manager
Phone
(586) 254-7593

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

42141 Mound Rd
Sterling Heights, MI 48314-3144

Mailing address

42141 Mound Rd
Sterling Heights, MI 48314-3144
Phone (586) 254-7593

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0952600Pediatric Healthcare/Sharon MC Manus42141 Mound Road Suite B, Sterling Heights, MI 48314Certificate of waiverJun 14, 2027

National Provider Directory

National Provider Directory

Locations

42141 Mound Rd
Sterling Heights, MI 48314
Phone (586) 254-7593

42141 Mound Rd
Ste B
Sterling Heights, MI 48314
Phone (586) 254-7593

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962446567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42141 MOUND RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483143144",
            "telephone_number": "586-254-7593",
            "fax_number": "586-254-7834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42141 MOUND RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483143144",
            "telephone_number": "586-254-7593",
            "fax_number": "586-254-7834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MULDOON",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "586-254-7593",
        "authorized_official_credential": "CMA"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sterling Heights, MI

Sources for this page

  • 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.
  • 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.