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GREAT LAKES PEDIATRICS
NPI 1417126715
Pediatrics - Adolescent Medicine in Warren, MI

Active since February 21, 2008CLIA 23D2023019 · Waiver
26000 HOOVER RD, 103, WARREN, MI 48089(586) 427-1351 Get Directions Write a Review

NPPES record last updated: February 21, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Great Lakes Pediatrics NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREAT LAKES PEDIATRICS (NPI 1417126715) is a healthcare organization registered as an adolescent medicine in Warren, Michigan and active in the NPI registry since February 2008. The organization holds a CLIA Waiver certificate valid through April 13, 2027 and lists Sundus Rummani-askar, President, as its authorized official.

NPPES Registry Identity

NPI1417126715
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameGREAT LAKES PEDIATRICS
Location Address26000 HOOVER RD, 103Warren, MI 48089-1167
Mailing Address26000 Hoover Rd, 103Warren, MI 48089-1167 · (586) 427-1351
Phone(586) 427-1351
Organization SubpartNo
Authorized OfficialSundus Rummani-askarPresident · (586) 427-1351
Enumeration DateFebruary 21, 2008
✔ NPI 1417126715 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in MI · 4301073962
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
26000 HOOVER RD, Warren, MI 48089
Open in Google Maps ↗

Other Identifiers 1

Medicaid4435267MI

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2023019

Great Lakes Pediatric · Warren, MI
Active · expires Apr 13, 2027
CLIA Number23D2023019
Laboratory TypePhysician Office
Certificate Effective DateApril 14, 2025
Certificate Expiration DateApril 13, 2027
Laboratory DirectorSundus Rummari-Askar
Laboratory Phone(586) 427-1351
Laboratory LocationGreat Lakes Pediatric13430 13 Mile, Warren, MI 48088
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAURA SAYLOR PA-C
Physician Assistant
26000 HOOVER RD
WARREN, MI 48089
Macomb County (586) 722-0707
WARREN PHARMACY
Pharmacy (Community/Retail Pharmacy)
26000 HOOVER RD
WARREN, MI 48089
Macomb County (586) 754-0000
WARREN FAMILY MEDICAL CENTER PLLC
Family Medicine
26000 HOOVER RD, 100
WARREN, MI 48089
Macomb County (586) 722-0707
STASIO CHIROPRACTIC CENTER P.C.
Chiropractor
26000 HOOVER RD, SUITE 110 STASIO CHIROPRACTIC CENTER
WARREN, MI 48089
Macomb County (586) 757-6285
PREMIER MEDICAL MOVEMENT MANAGEMENT COMPANY LLC
Physical Medicine & Rehabilitation (Pain Medicine)
26000 HOOVER RD
WARREN, MI 48089
Macomb County (586) 434-5260
ROSE WARDA ATRIS
Internal Medicine
26000 HOOVER RD
WARREN, MI 48089
Macomb County (586) 722-0707
NIDAL HAMMOUD M.D.
Family Medicine
26000 HOOVER RD
WARREN, MI 48089
Macomb County (586) 722-0707
HOOVER FAMILY DENTAL PLLC
Clinic/Center (Dental)
26000 HOOVER RD, SUITE # 102
WARREN, MI 48089
Macomb County (586) 480-2256

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Great Lakes Pediatrics's NPI number?

The NPI number for Great Lakes Pediatrics is 1417126715. It was assigned to this organization in the NPPES registry on February 21, 2008.

Where is Great Lakes Pediatrics located?

Great Lakes Pediatrics is located at 26000 Hoover Rd 103, Warren, MI 48089. The listed phone number is (586) 427-1351.

What is Great Lakes Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Great Lakes Pediatrics hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2023019) is associated with this NPI, valid through April 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Great Lakes Pediatrics accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Great Lakes Pediatrics as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Great Lakes Pediatrics was last updated on February 21, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.