Healthcare Provider Details

I. General information

NPI: 1528145810
Provider Name (Legal Business Name): INDEPENDENCE HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W HURON RD
AU GRES MI
48703-9543
US

IV. Provider business mailing address

400 W HURON RD
AU GRES MI
48703-9543
US

V. Phone/Fax

Practice location:
  • Phone: 989-876-8375
  • Fax:
Mailing address:
  • Phone: 989-876-8375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501008587
License Number StateMI

VIII. Authorized Official

Name: MR. JOGINDER SINGH
Title or Position: PRESIDENT
Credential: PT
Phone: 989-876-8375