| Professional Primary Care Services Pc | |
|
43996 Woodward Ave Ste 104 Bloomfield Hills MI 48302-5028 | |
| (248) 977-4138 | |
| Not Available |
| Full Name | Professional Primary Care Services Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 43996 Woodward Ave Ste 104, Bloomfield Hills, Michigan |
| Authorized Official Name and Position | Jayakar Reddy Kanmantha Reddy (PRESIDENT) |
| Authorized Official Contact | 2483966667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Primary Care Services Pc Po Box 7752 Bloomfield Hills MI 48302-7752 Ph: (248) 396-6667 | Professional Primary Care Services Pc 43996 Woodward Ave Ste 104 Bloomfield Hills MI 48302-5028 Ph: (248) 977-4138 |
| NPI Number | 1588852933 |
|---|---|
| Provider Enumeration Date | 10/11/2007 |
| Last Update Date | 07/11/2011 |
| Medicare PECOS PAC ID | 5294798187 |
|---|---|
| Medicare Enrollment ID | O20041111000261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588852933 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 4301068131 (Michigan) | Primary |
| Provider Name | Jayakar Reddy Kanmantha Reddy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1629086244 PECOS PAC ID: 2365405255 Enrollment ID: I20041118001122 |
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