Basic Information
| Provider Information | |||||||||
| NPI: | 1740227743 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BACKOS | ||||||||
| FirstName: | ALCESA | ||||||||
| MiddleName: | ABELGAS | ||||||||
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| Credential: | MD FAAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 SAINT ANTOINE ST | ||||||||
| Address2: | UHC 5D MAILBOX 226 UNIVERSITY PEDIATRICIANS | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454405 | ||||||||
| FaxNumber: | 3139660665 | ||||||||
| Practice Location | |||||||||
| Address1: | CHILDREN'S HOSPITAL OF MI | ||||||||
| Address2: | 3950 BEAUBIEN | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138328290 | ||||||||
| FaxNumber: | 3139930081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 01/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301048246 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | 4301048246 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.