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Grace Pediatrics PC

Clinic/Center, Primary Care in Pontiac, MI. Organization (NPI-2).

NPI number1003482019
StatusActive
Last updated in NPPESJun 1, 2021

Details

NPI
1003482019
Entity type
Organization (NPI-2)
Legal business name
Grace Pediatrics PC
Organization subpart
No
Enumeration date
Jun 1, 2021
Certification date
Jun 1, 2021
Last updated
Jun 1, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP2300X Clinic/Center, Primary Care––Yes

Practice location

44200 Woodward Ave Ste 103
Pontiac, MI 48341-5046

Phone 248-253-9600 · Fax 248-253-0980

Mailing address

44200 Woodward Ave Ste 103
Pontiac, MI 48341-5046

Phone 248-253-9600 · Fax 248-253-0980

Authorized official

Roy Pullukat
Owner
2488843879

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