Basic Information
| Provider Information | |||||||||
| NPI: | 1417121252 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DETROIT RIVERVIEW PEDIATRICS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT 999360 PO BOX 33738 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482323738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107205715 | ||||||||
| FaxNumber: | 8107320891 | ||||||||
| Practice Location | |||||||||
| Address1: | 10201 E JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482143149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138213777 | ||||||||
| FaxNumber: | 3138243777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2008 | ||||||||
| LastUpdateDate: | 11/12/2015 | ||||||||
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| AuthorizedOfficialLastName: | MOSBY | ||||||||
| AuthorizedOfficialFirstName: | GERARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3138213777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.