Provider Demographics
NPI:1275680753
Name:PROFESSIONAL OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, PLC
Entity Type:Organization
Organization Name:PROFESSIONAL OCCUPATIONAL AND ENVIRONMENTAL MEDICINE, PLC
Other - Org Name:PROFESSIONAL PREVENTATIVE MEDICINE, PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BINDESH
Authorized Official - Middle Name:KIRITKUMAR
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-934-4854
Mailing Address - Street 1:49025 WOODSON WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-6673
Mailing Address - Country:US
Mailing Address - Phone:734-934-4854
Mailing Address - Fax:
Practice Address - Street 1:10000 TELEGRAPH RD
Practice Address - Street 2:THE CENTER FOR WOUND HEALING & HYPERBARIC MEDICINE
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3330
Practice Address - Country:US
Practice Address - Phone:313-295-5343
Practice Address - Fax:313-295-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010788972083P0011X, 261QP2300X, 261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0951039OtherBLUE CROSS BLUE SHIELD
MI0951039OtherBLUE CROSS BLUE SHIELD
MIMI4164001Medicare PIN