# PAUL PETRE MD PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PAUL PETRE MD PC
- **Other names:** Great Lakes Portable Diagnostics
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1750536454
- **Legal business name:** PAUL PETRE MD PC
- **Authorized official:** PAUL PETRE MD (PRESIDENT)
- **Authorized official phone:** (586) 573-6400

## Contact information

- **Practice address:** 28800 RYAN RD, SUITE 300, WARREN, MI 48092-4272
- **Practice address phone:** (586) 573-6400
- **Practice address fax:** (586) 573-1918
- **Mailing address:** 30781 STEPHENSON HWY, MADISON HTS, MI 48071-1618
- **Mailing address phone:** (248) 284-2316
- **Mailing address fax:** (248) 583-8969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 11/21/2008
- **Last updated:** 11/21/2008