Organization
BAY POINTE MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE ANN PRADKO MD (PRESIDENT)
(586) 725-7686
Entity
Organization
Contact information
Practice address
32740 23 MILE RD, CHESTERFIELD, MI 48047-1978
(586) 725-7686
Mailing address
32740 23 MILE RD, CHESTERFIELD, MI 48047-1978
(586) 725-7686
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
4301060263
MI
261QP2300X
Primary Care Clinic/Center
Primary
4301074972
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0805009052
BLUE CROSS BLUE SHIELD
—
01
—
0805017681
BLUE CROSS BLUE SHIELD PIN
—
01
—
1770558769
NPI JAMES PRADKO MD
—
01
—
1871568204
NPI JACQUELINE PRADKO MD
—
01
—
P00230505
MEDICARE RAILROAD
—
Enumeration date
01/12/2009
Last updated
01/12/2009
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