Healthcare Provider Details

I. General information

NPI: 1578692307
Provider Name (Legal Business Name): STAT PAIN MANAGEMENT & REHABILITATION SPECIALTIES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2883 HAWKS RD
ANN ARBOR MI
48108-1318
US

IV. Provider business mailing address

2883 HAWKS RD
ANN ARBOR MI
48108-1318
US

V. Phone/Fax

Practice location:
  • Phone: 734-434-6246
  • Fax: 734-434-2307
Mailing address:
  • Phone: 734-434-6246
  • Fax: 734-434-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL ROZELLE
Title or Position: OWNER
Credential:
Phone: 734-434-6246