Provider Demographics
NPI:1306538889
Name:WARRENDALE PEDIATRICS
Entity type:Organization
Organization Name:WARRENDALE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-213-7538
Mailing Address - Street 1:17600 W WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3509
Mailing Address - Country:US
Mailing Address - Phone:313-551-5141
Mailing Address - Fax:248-684-5510
Practice Address - Street 1:17600 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3509
Practice Address - Country:US
Practice Address - Phone:313-551-5141
Practice Address - Fax:248-684-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty