PROFESSIONAL MEDICAL CENTER PC NPI 1619985058

NPI Information

  • NPI: 1619985058
  • Provider Name: PROFESSIONAL MEDICAL CENTER PC
  • Classification: Pediatrics - 208000000X
  • Entity Type: Organization
  • CLIA Number: 23D2011606
  • Address: 3956 MOUNT ELLIOTT ST
    DETROIT, MI
    ZIP 48207
  • Phone: (313) 925-4540

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NPI Details

PROFESSIONAL MEDICAL CENTER PC is a pediatrics in Detroit, MI. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. PROFESSIONAL MEDICAL CENTER PC NPI is 1619985058. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3956 MOUNT ELLIOTT ST
DETROIT, MI
ZIP 48207-841
Phone: (313) 925-4540
Fax: (313) 925-0322

The provider's authorized official is Augustine K Kole-james .
The authorized official title is President and has the following contact phone number (313) 925-4540.

The CLIA number assigned to this NPI record is 23D2011606 - other - hiv and hcv rapid test with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/3/2006 and was last updated on 9/11/2025.

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
1207Q00000XFamily MedicineNo
2207R00000XInternal MedicineNo
3207V00000XObstetrics & GynecologyNo
4208000000XPediatricsYes

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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