Provider Demographics
NPI:1972770956
Name:NOVI PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:NOVI PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANISHA
Authorized Official - Middle Name:RAJUL
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-465-4847
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:455
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1209
Mailing Address - Country:US
Mailing Address - Phone:248-465-4847
Mailing Address - Fax:248-465-4477
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:455
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1209
Practice Address - Country:US
Practice Address - Phone:248-465-4847
Practice Address - Fax:248-465-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37492OtherBCBS GROUP