Provider Demographics
NPI:1447689302
Name:DUNDEE PEDIATRICS, PLLC
Entity type:Organization
Organization Name:DUNDEE PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DAILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-823-5437
Mailing Address - Street 1:120 WATERSTRADT COMMERCE DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUNDEE
Mailing Address - State:MI
Mailing Address - Zip Code:48131-9681
Mailing Address - Country:US
Mailing Address - Phone:734-823-5437
Mailing Address - Fax:734-823-5436
Practice Address - Street 1:120 WATERSTRADT COMMERCE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DUNDEE
Practice Address - State:MI
Practice Address - Zip Code:48131-9681
Practice Address - Country:US
Practice Address - Phone:734-823-5437
Practice Address - Fax:734-823-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269680302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization