MEDICARE: PROMED PREFERRED MI 3, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1467258095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMED PREFERRED MI 3, PLLC

Provider Business Mailing Address
First Line	:	329 S OYSTER BAY RD # 2059
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-3301
Country	:	US
Telephone Number	:	313-566-4220
Fax Number	:

Provider Business Practice Location Address
First Line	:	28533 FORD RD STE B
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2843
Country	:	US
Telephone Number	:	313-284-1144
Fax Number	:	313-447-4475

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEV GRINMAN
Credential	:	MD
Telephone Number	:	313-566-4220

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	05/28/2026

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