| Promed Primary Care Pllc | |
|
19041 E 12 Mile Rd Ste 103 Roseville MI 48066-2609 | |
| (248) 632-8182 | |
| (586) 200-0149 |
| Full Name | Promed Primary Care Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 19041 E 12 Mile Rd Ste 103, Roseville, Michigan |
| Authorized Official Name and Position | Manolis Kyriacou (OWNER) |
| Authorized Official Contact | 2486328182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Promed Primary Care Pllc 19041 E 12 Mile Rd Ste 103 Roseville MI 48066-2609 Ph: (248) 632-8182 | Promed Primary Care Pllc 19041 E 12 Mile Rd Ste 103 Roseville MI 48066-2609 Ph: (248) 632-8182 |
| NPI Number | 1336808864 |
|---|---|
| Provider Enumeration Date | 12/13/2021 |
| Last Update Date | 12/13/2021 |
| Medicare PECOS PAC ID | 8820480007 |
|---|---|
| Medicare Enrollment ID | O20220120000855 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336808864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Manolis S Kyriacou |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710193354 PECOS PAC ID: 2365524253 Enrollment ID: I20080131000116 |
| Provider Name | Ankur Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245636091 PECOS PAC ID: 4183767882 Enrollment ID: I20150123000667 |
| Provider Name | Rochelle Lenetta Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184083974 PECOS PAC ID: 9638459761 Enrollment ID: I20161207002326 |
| Provider Name | Rupinder K Dadiala |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730761594 PECOS PAC ID: 8325449788 Enrollment ID: I20210623002559 |
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