GRACE PEDIATRICS PC NPI 1003482019

NPI Information

  • NPI: 1003482019
  • Provider Name: GRACE PEDIATRICS PC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • CLIA Number: 23D2275082
  • Address: 44200 WOODWARD AVE STE 103
    PONTIAC, MI
    ZIP 48341
  • Phone: (248) 253-9600

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NPI Details

GRACE PEDIATRICS PC is a primary care clinic center in Pontiac, MI. GRACE PEDIATRICS PC NPI is 1003482019. The provider is registered as an organization entity type.

The provider's business location address is:

44200 WOODWARD AVE STE 103
PONTIAC, MI
ZIP 48341-046
Phone: (248) 253-9600
Fax: (248) 253-0980

The provider's authorized official is Roy Pullukat .
The authorized official title is Owner and has the following contact phone number (248) 884-3879.

The CLIA number assigned to this NPI record is 23D2275082 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/1/2021 and was last updated on 6/1/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QP2300XClinic/CenterPrimary CareYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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