Organization
MAPLE MILLENNIUM MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRAMOD KERKAR MD (OWNER)
(586) 977-7246
Entity
Organization
Contact information
Practice address
5456 15 MILE RD, STERLING HEIGHTS, MI 48310-5110
(586) 977-7246
Mailing address
5456 15 MILE RD, STERLING HEIGHTS, MI 48310-5110
(586) 977-7246
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
506851
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23C0001058
HEALTH ALLIANCE PLAN
MI
01
—
40346
BCBS MI
—
Enumeration date
01/31/2007
Last updated
02/17/2011
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