OrganizationActive
William Beaumont Hospital
NPI 1104040153 · Pediatrics Physician · Royal Oak, MI
Provider details
- NPI number
- 1104040153
- Entity type
- Organization
- Primary specialty
- Pediatrics PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- William Beaumont Hospital
- Organization subpart
- Yes
- Authorized official
- Lee Odom, President Shared Services(947) 522-3326
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone: (248) 423-2454
Fax: (248) 423-2576
Street-level locationGet directions
Mailing address
26901 Beaumont Blvd
Southfield, MI 48033-3849
Other names (DBA / former)
- Doing business as
- Beaumont Professional Services
- Doing business as
- Beaumont Professional Services
Registry dates
- Enumerated
- 2007-04-12
- Last updated
- 2021-10-01
- Certified
- 2021-10-01
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.