Basic Information
| Provider Information | |||||||||
| NPI: | 1912052010 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILD AND ADULT MEDICINE OF GRAND BLANC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8235 HOLLY RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484392441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106949110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8235 HOLLY RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484392441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106949110 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | AKRAWI | ||||||||
| AuthorizedOfficialFirstName: | HABIB | ||||||||
| AuthorizedOfficialMiddleName: | KHALID | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8106949110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301067790 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.