PROFESSIONAL MEDICAL CENTER PC (NPI# 1619985058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619985058 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL MEDICAL CENTER PC |
| Practice Address |
3956 Mount Elliott St Detroit MI 48207-1841 |
| Mailing Address |
Po Box 3160 Detroit MI 48203-0160 |
| Practice Telephone | 3139254540 |
| Practice Fax Number | 3139250322 |
| Mailing Telephone | 3139254540 |
| Mailing Fax Number | 3139250322 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | AUGUSTINE K KOLE-JAMES (PRESIDENT) |
| Authorized Official Telephone | 3139254540 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| X | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| X | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
| X | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Street Address |
3956 MOUNT ELLIOTT ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48207-1841 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063982312 | Ellen L Anderson | Registered Nurse | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2018-11-29 |
| 1134620008 | Laneice Jones | Social Worker | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2018-02-26 |
| 1306271135 | Cassandra Rena Viney | Nurse Practitioner | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2013-09-11 |
| 1043561277 | Temitope Oladokun Olagbaiye | Nurse Practitioner | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2012-09-27 |
| 1497004527 | Kasheena T Shropshire | Nurse Practitioner | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2012-09-05 |
| 1568695179 | Angela Michele Allen | Nurse Practitioner | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2009-08-29 |
| 1891922613 | Omosalewa Itauma | Obstetrics & Gynecology | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2009-06-18 |
| 1407012834 | Henri Godbold | Internal Medicine | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2008-08-05 |
| 1811044118 | Pro Care Helath Plan Inc. | Health Maintenance Organization | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2007-01-05 |
| 1093725186 | Usha L Doshi | Pediatrics | 3956 Mount Elliott St, Detroit, MI 48207-1841 | 2006-08-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245848506 | Anton R Gonzales | Physical Therapy Assistant | 2295 Chene, Detroit, Mi 48207, Detroit, MI 48207 | 2020-07-22 |
| 1033733928 | Taleshia Moss | Occupational Therapist | 2295 Chene, Detroit, MI 48207 | 2020-06-05 |
| 1942858550 | Ronald Royce Cochran | Counselor | 2925 Russell St, Detroit, Detroit, MI 48207 | 2019-08-27 |
| 1649831439 | Charday Penick | Social Worker | Team Wellness, 2925 Russell St, Detroit, MI 48207 | 2019-06-24 |
| 1568023349 | Alphia Ramona Burgess | Social Worker | Team Wellness Center, 2925 Russell Street, Detroit, MI 48207 | 2019-06-24 |
| 1447741608 | Sherice Ward | Social Worker | 100 River Place Drive, Ste 250, Detroit, MI 48207 | 2018-05-23 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1043723737 | Olivia Carter | Case Management | 2712 Gratiot, Detroit, MI 48207 | 2017-11-16 |
| 1558885590 | Kalimah Johnson | Social Worker | 701 Mcdougall, Detroit, MI 48207 | 2017-08-01 |
| 1922534692 | Angela Young | Social Worker | 100 River Place 520, Detroit, MI 48207 | 2017-05-02 |
| Find all providers in zip 48207 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194354811 | Lorie Ann Turner | Family Medicine | 1728 Sheridan St, Detroit, MI 48214-2410 | 2020-04-04 |
| 1134787633 | Behavioral Health Professionals, Inc | Family Medicine | 19750 Burt Road, Detroit, MI 48219 | 2019-05-31 |
| 1508326687 | Randi Nguyen | Family Medicine | 22151 Moross Rd Ste 212, Detroit, MI 48236-2177 | 2019-03-23 |
| 1982194338 | Green Cross Medical Center PC | Family Medicine | 18041 Greenfield Rd, Detroit, MI 48235-3120 | 2018-05-11 |
| 1205339306 | Conant Family Care Pllc | Family Medicine | 3611 Carpenter St Ste 5, Detroit, MI 48212-2784 | 2018-03-14 |
| 1801303086 | St Mary Mercy Physician Practices | Family Medicine | 5555 Conner St Ste 2691, Detroit, MI 48213-3812 | 2018-01-09 |
| 1427408376 | Raquel Orlich | Family Medicine | 1620 Michigan Ave Ste 125, Detroit, MI 48216-1493 | 2016-06-21 |
| 1295181543 | Ammar Charestan | Family Medicine | 6071 Outer Dr W, Detroit, MI 48235 | 2016-05-05 |
| 1629423652 | Rajni Parmar | Family Medicine | 6001 W Outer Dr Ste 430, Detroit, MI 48235-2626 | 2016-04-27 |
| 1265886733 | Benjamin Abraham | Family Medicine | One Ford Place 2e, Henry Ford Hospital, Department of Family Medicine, Detroit, MI 48202 | 2016-04-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.