Basic Information
| Provider Information | |||||||||
| NPI: | 1861966244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE CARE MEDICAL GROUP OF MI, PLLC | ||||||||
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| OtherOrganizationName: | PROGRESSIVE CARE MEDICAL GROUP OF MI, PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 EILEEN WAY UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117915313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168555255 | ||||||||
| FaxNumber: | 5169212451 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 FORD RD | ||||||||
| Address2: | |||||||||
| City: | WHITE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483833120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168555255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2019 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | DEEPAK | ||||||||
| AuthorizedOfficialMiddleName: | RAMESHCHANDRA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8453395100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.