Organization
COOLMAC MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRAMOD RAVAL M.D. (PRESIDENT)
(313) 838-7900
Entity
Organization
Contact information
Practice address
14825 W MCNICHOLS RD, DETROIT, MI 48235-3939
(313) 838-7900
(313) 838-3476
Mailing address
28712 WINTERGREEN, FARMINGTON HILLS, MI 48331-3018
(313) 838-7900
(313) 838-3476
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301043240
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0631385
PTAN
MI
01
—
4301043240
PHYSICIAN LICENSE
MI
Enumeration date
07/31/2012
Last updated
07/31/2012
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