Provider Demographics
NPI:1992919203
Name:WEST BLOOMFIELD PEDIATRICS PLLC
Entity type:Organization
Organization Name:WEST BLOOMFIELD PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GLICKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-788-1200
Mailing Address - Street 1:46325 WEST TWELVE MILE ROAD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-596-1000
Mailing Address - Fax:248-305-8250
Practice Address - Street 1:6400 FARMINGTON ROAD
Practice Address - Street 2:SUITE TEN
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-788-1200
Practice Address - Fax:248-788-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301086791208000000X
MI4301076640208000000X
MI5101006183208000000X
MI4301068662208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty