PROACTIVE MD MI PLLC NPI 1255106498

NPI Information

  • NPI: 1255106498
  • Provider Name: PROACTIVE MD MI PLLC
  • Classification: Clinic/Center - 261QP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • Doing Business As: PROACTIVE MD-L&L HEALTH CENTER
  • CLIA Number: 23D2298158
  • Address: 164 MCLEAN
    BRUCE TWP, MI
    ZIP 48065
  • Phone: (864) 501-0751

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NPI Details

PROACTIVE MD MI PLLC is a primary care clinic center in Bruce Twp, MI. PROACTIVE MD MI PLLC NPI is 1255106498. The provider is registered as an organization entity type.
The provider Is Doing Business As Proactive Md-l&l Health Center.

The provider's business location address is:

164 MCLEAN
BRUCE TWP, MI
ZIP 48065-919
Phone: (864) 501-0751

The provider's authorized official is Daria Jones .
The authorized official title is Operations Project Coordinator and has the following contact phone number (864) 501-0751.

The CLIA number assigned to this NPI record is 23D2298158 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/17/2023 and was last updated on 12/22/2023.

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: 11/21/2025

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