Provider Demographics
NPI:1699940866
Name:PEDIATRICS CRITIACL CARE ASSOCIATES
Entity type:Organization
Organization Name:PEDIATRICS CRITIACL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUREIKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-953-9547
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48480-0959
Mailing Address - Country:US
Mailing Address - Phone:810-953-9547
Mailing Address - Fax:
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:810-953-9547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0463282080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102630647Medicaid
MI350B56262OtherBLUE CROSS AND BLUE SHIELD OF MI
MI=========OtherTAX ID