Provider Demographics
NPI:1629215769
Name:BAY POINTE MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:BAY POINTE MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PRADKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-725-7686
Mailing Address - Street 1:32740 23 MILE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-1978
Mailing Address - Country:US
Mailing Address - Phone:586-725-7686
Mailing Address - Fax:
Practice Address - Street 1:32740 23 MILE RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-1978
Practice Address - Country:US
Practice Address - Phone:586-725-7686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074972261QP2300X
MI4301060263261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0805017681OtherBLUE CROSS BLUE SHIELD PIN
1871568204OtherNPI JACQUELINE PRADKO MD
1770558769OtherNPI JAMES PRADKO MD
P00230505OtherMEDICARE RAILROAD
0805009052OtherBLUE CROSS BLUE SHIELD
1871568204OtherNPI JACQUELINE PRADKO MD
1770558769OtherNPI JAMES PRADKO MD
F73943Medicare UPIN
OM85280Medicare PIN