Provider Demographics
NPI:1386139913
Name:SOUTHFIELD PEDIATRICS PLLC
Entity type:Organization
Organization Name:SOUTHFIELD PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEBARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-557-0160
Mailing Address - Street 1:28500 SOUTHFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2722
Mailing Address - Country:US
Mailing Address - Phone:248-557-0160
Mailing Address - Fax:248-557-1756
Practice Address - Street 1:28500 SOUTHFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2722
Practice Address - Country:US
Practice Address - Phone:248-557-0160
Practice Address - Fax:248-557-1756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI046484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1491727Medicaid