Provider Demographics
NPI:1689012601
Name:PEDIATRIC AND ADOLESCENT CARE ASSOCIATES, PC
Entity type:Organization
Organization Name:PEDIATRIC AND ADOLESCENT CARE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOBANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-731-1500
Mailing Address - Street 1:43184 DEQUINDRE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1709
Mailing Address - Country:US
Mailing Address - Phone:586-731-1500
Mailing Address - Fax:586-731-1363
Practice Address - Street 1:43184 DEQUINDRE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1709
Practice Address - Country:US
Practice Address - Phone:586-731-1500
Practice Address - Fax:586-731-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077847208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty