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General NPI Number Information
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NPI Number | 1437468063
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PRIMARY CARE PC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 24559 PERCEVAL LN
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City | NOVI
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State | MI
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Zip | 48375-2355
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Country | US
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Telephone | 248-259-1214
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 707
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City | NOVI
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State | MI
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Zip | 48376-0707
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Country | US
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Telephone | 248-259-1214
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DHANANJAY KUMAR
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Credential | M.D.
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Telephone | 248-259-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301075870
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License Number State | MI
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