PAUL PETRE MD PC (NPI# 1750536454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750536454 |
| Entity Type | Organization |
| Organization Name | PAUL PETRE MD PC |
| Other Organization Name | GREAT LAKES PORTABLE DIAGNOSTICS |
| Practice Address |
28800 Ryan Rd Suite 300 Warren MI 48092-4272 |
| Mailing Address |
30781 Stephenson Hwy Madison Hts MI 48071-1618 |
| Practice Telephone | 5865736400 |
| Practice Fax Number | 5865731918 |
| Mailing Telephone | 2482842316 |
| Mailing Fax Number | 2485838969 |
| Enumeration Date | 2008-11-21 |
| Last Update Date | 2008-11-21 |
| Authorized Official Name | PAUL PETRE (PRESIDENT) |
| Authorized Official Telephone | 5865736400 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | PAUL PETRE MD PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | Suppliers |
| Other Name | Type Code |
|---|---|
| Great Lakes Portable Diagnostics | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881868685 | Paul Petre Md PC | Family Medicine | 28800 Ryan Rd, Warren, MI 48092-4272 | 2008-04-14 |
| 1700076726 | Paul Petre Md PC | General Practice | 363 W Big Beaver Rd, Suite 200, Troy, MI 48084-5220 | 2007-07-26 |
| 1225167349 | Paul Petre Md PC | Surgery | 24362 Rensselaer St, Oak Park, MI 48237-1781 | 2007-03-05 |
| Street Address |
28800 RYAN RD SUITE 300 |
| City | WARREN |
| State | MI |
| Zip Code | 48092-4272 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710967815 | Gary G Gilyard | Orthopaedic Surgery | 28800 Ryan Rd, Suite 280, Warren, MI 48092-4272 | 2006-01-17 |
| 1982055943 | Melissa Wummel | Social Worker | 28800 Ryan Rd, Ste 320, Warren, MI 48092-4272 | 2016-06-30 |
| 1477920510 | Yasmin Keshavjee | Family Medicine | 28800 Ryan Rd, Suite 320, Warren, MI 48092-4272 | 2015-08-24 |
| 1033502224 | Neurocognitive Center of Michigan Group | Psychologist | 28800 Ryan Rd, Suite 300, Warren, MI 48092-4272 | 2015-03-11 |
| 1801207907 | Kathryn Aurand | Physician Assistant | 28800 Ryan Rd, Suite 280, Warren, MI 48092-4272 | 2014-05-12 |
| 1952721862 | Samantha Reichling | Specialist | 28800 Ryan Rd, Warren, MI 48092-4272 | 2014-04-17 |
| 1700204328 | Neurocognitive Center of Michigan Inc. | Psychologist | 28800 Ryan Rd, Suite 320, Warren, MI 48092-4272 | 2014-04-01 |
| 1487081782 | Sara Louise Blomeling-deroo | Social Worker | 28800 Ryan Rd, Suite 320, Warren, MI 48092-4272 | 2013-10-01 |
| 1275872376 | Dima Sprague | Physician Assistant | 28800 Ryan Rd, Warren, MI 48092-4272 | 2013-02-08 |
| 1568712370 | Behavioral Infermiera Care Solutions Inc | Psychologist | 28800 Ryan Rd, Suite 320, Warren, MI 48092-4272 | 2012-09-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881163186 | Katherine Byrd | Behavior Technician | 3691 East 11 Mile Rd., Warren, MI 48092 | 2018-11-15 |
| 1861980302 | Mark Paul Azzo | Home Health Aide | 27605 Walker Ave, Warren, MI 48092 | 2018-04-30 |
| 1144747130 | Joseph Galutan Estrada | Chiropractor | 4846 Marlow Dr, Warren, MI 48092 | 2017-08-29 |
| 1649669425 | Lawrence Mosurak IIi | Chiropractor | 6201 Chicago Road, Warren, MI 48092 | 2015-01-15 |
| 1174911713 | Kimberly A Ott | Nurse Practitioner | 28800 Ryan Rd Suite 320, Warren, MI 48092 | 2015-01-06 |
| 1487071999 | Michele Szandzik | Chiropractor | 2243 East 12 Mile Rd, Warren, MI 48092 | 2014-03-21 |
| 1962827311 | Mouradian Dental Center, D.d.s., P.C. | Dentist | 32500 Mound Rd., Mouradian Dental Center, D.d.s., P.C., Warren, MI 48092 | 2014-02-21 |
| 1639495930 | Debra Kay Wenneman | Physical Therapist | 28776 Ryan Rd, Warren, MI 48092 | 2010-04-12 |
| 1922332923 | Sonia Amirali Pethani | Physical Therapist | 2117 E. Eleven Mile Rd., Warren, MI 48092 | 2009-09-23 |
| 1881822237 | Michael Patrick Walsh | Orthopaedic Surgery | 28800 Ryan Rd Ste 310, Warren, MI 48092 | 2009-06-24 |
| Find all providers in zip 48092 | ||||
| Taxonomy Code | 335V00000X |
| Grouping | Suppliers |
| Classification | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| A supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed. |
| Notes: Source: National Uniform Claim Committee, 2015 [1/1/2016: title and definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053602532 | Camcade Imaging Inc | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 200 Hill St, Warren, AR 71671-2483 | 2011-05-02 |
| 1912078536 | Psi Radiological Service, Inc | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 8529 E 8 Mile Rd, Warren, MI 48089-3067 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396362406 | Rapid Diagnostics LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 24450 Evergreen Rd Ste 215b, Southfield, MI 48075-5546 | 2020-07-06 |
| 1699232223 | Indeal LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 1192 Bembridge Dr, Rochester Hills, MI 48307-5715 | 2019-03-01 |
| 1790299964 | Pegasus Diagnostics | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3686 Brandi Dr, Sterling Heights, MI 48310-2538 | 2017-11-27 |
| 1255692646 | Mxdiagnostics, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 24901 Northwestern Hwy Ste 609, Southfield, MI 48075-2210 | 2012-06-03 |
| 1386972602 | Am Diagnostics | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 17520 W 12 Mile Road, Suite 108, Southfield, MI 48076-1945 | 2009-11-24 |
| 1487982922 | Bobchi Inverciones L.L.C. | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 3628 Shady Ridge Rd, Jackson, MI 49201-9352 | 2009-11-20 |
| 1912169186 | Medical Diagnostic Services Inc | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 4479 Pontiac Lake Rd, Suite 1d, Waterford, MI 48328-2059 | 2008-06-30 |
| 1114118171 | Zoomx Mobile Diagnostic Services, LLC | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 30230 Orchard Lake Rd, Suite 100, Farmington Hills, MI 48334-2267 | 2007-08-06 |
| 1295952745 | Op Therapy, Inc. | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 7760 Kochville Rd, Freeland, MI 48623-8655 | 2007-04-19 |
| 1043344690 | Patrick W Bozarth | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | 227 N 9th St, Escanaba, MI 49829-3815 | 2007-03-15 |
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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.