MEDICARE: WEST MICHIGAN REHABILITATION PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1780614909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST MICHIGAN REHABILITATION PC

Provider Business Mailing Address
First Line	:	3491 LINCOLN RD
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9533
Country	:	US
Telephone Number	:	269-751-2150
Fax Number	:	616-392-7959

Provider Business Practice Location Address
First Line	:	3491 LINCOLN RD
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9533
Country	:	US
Telephone Number	:	269-751-2150
Fax Number	:	616-392-7959

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEONARD R. FAZIO
Credential	:
Telephone Number	:	269-751-2150

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/25/2023

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