MEDICARE: PRO MED MANAGEMENT INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1477590917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO MED MANAGEMENT INC

Provider Business Mailing Address
First Line	:	53950 VAN DYKE AVE
Second Line	:	STE 210B
City	:	SHELBY TWP
State	:	MI
Zip	:	48316
Country	:	US
Telephone Number	:	586-781-8400
Fax Number	:	586-781-8300

Provider Business Practice Location Address
First Line	:	53950 VAN DYKE AVE
Second Line	:	STE 210B
City	:	SHELBY TWP
State	:	MI
Zip	:	48316
Country	:	US
Telephone Number	:	586-781-8400
Fax Number	:	586-781-8300

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	MR. KARL LAWRENCE SENKOWSKI
Credential	:	LMSW
Telephone Number	:	586-781-8400

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	08/22/2020

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