Grace Pediatrics PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

GRACE PEDIATRICS PC

Practice address

44200 Woodward Ave Ste 103
Pontiac, MI 48341-5046

Phone

(248) 253-9600

Fax

(248) 253-0980

NPI assigned

Jun 1, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roy Pullukat, MDNPI 1346537289

Title

Owner

Phone

(248) 884-3879

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roy J Pullukat, M.D.

  • Pediatrics Physician
  • Pontiac, MI
  • NPI 1346537289
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622505600000",
    "number": "1003482019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44200 WOODWARD AVE STE 103",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415046",
            "telephone_number": "248-253-9600",
            "fax_number": "248-253-0980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44200 WOODWARD AVE STE 103",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415046",
            "telephone_number": "248-253-9600",
            "fax_number": "248-253-0980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A",
        "authorized_official_last_name": "PULLUKAT",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-884-3879",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Gordon, LMSW
• William Henry Gordon, M.D.
• Carol Goubeaux, P.T.
• Kanika Goyal
• Busra Gozaydinoglu, MD
• Graceful Living Home Care LLC
• Brian Graham
• Larry J Graham Jr.
• Daniel Grandberry
• Kathryn Grappin, LMSW

• Primary Care Clinic/Center in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Primary Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.