Basic Information
| Provider Information | |||||||||
| NPI: | 1689850133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POINTE MEDICAL CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20160 MACK AVE | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482361822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138820640 | ||||||||
| FaxNumber: | 3138823106 | ||||||||
| Practice Location | |||||||||
| Address1: | 20160 MACK AVE | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482361822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3138820640 | ||||||||
| FaxNumber: | 3138823106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2008 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | PULAPAKA | ||||||||
| AuthorizedOfficialFirstName: | SRINIVAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 3138820640 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.