Healthcare Provider Details

I. General information

NPI: 1861966244
Provider Name (Legal Business Name): PROGRESSIVE CARE MEDICAL GROUP OF MI, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 NORTHWIND DR
EAST LANSING MI
48823-5003
US

IV. Provider business mailing address

PO BOX 1040
SYOSSET NY
11791-0010
US

V. Phone/Fax

Practice location:
  • Phone: 800-860-3274
  • Fax:
Mailing address:
  • Phone: 800-860-3274
  • Fax: 888-910-1059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEEPAK RAMESHCHANDRA PATEL
Title or Position: OWNER
Credential:
Phone: 212-734-6621