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General NPI Number Information
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NPI Number | 1467258095
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Entity Type | Organization
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Legal Business Name | PROMED PREFERRED MI 3, PLLC
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 28533 FORD RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-2843
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Country | US
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Telephone | 313-566-4220
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Fax | 313-447-2777
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Provider Business Mailing Address
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Address Line | 329 S OYSTER BAY RD # 2059
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City | PLAINVIEW
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State | NY
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Zip | 11803-3301
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Country | US
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Telephone | 313-566-4220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEV GRINMAN
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Credential | MD
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Telephone | 313-566-4220
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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 |
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License Number State |
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