Provider Demographics
NPI:1871660324
Name:WEST BLOOMFIELD PEDIATRICS PLLC
Entity type:Organization
Organization Name:WEST BLOOMFIELD PEDIATRICS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:H
Authorized Official - Last Name:FORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-596-1000
Mailing Address - Street 1:46325 W 12 MILE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2462
Mailing Address - Country:US
Mailing Address - Phone:248-596-1000
Mailing Address - Fax:248-305-8250
Practice Address - Street 1:46325 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2456
Practice Address - Country:US
Practice Address - Phone:248-596-1000
Practice Address - Fax:248-230-5482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI350F317530OtherBCBS