Healthcare Provider Details

I. General information

NPI: 1083275937
Provider Name (Legal Business Name): PRM OF MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 E MAPLE RD
BIRMINGHAM MI
48009-6355
US

IV. Provider business mailing address

18 E 41ST ST RM 2002
NEW YORK NY
10017-6215
US

V. Phone/Fax

Practice location:
  • Phone: 646-481-4998
  • Fax:
Mailing address:
  • Phone: 646-481-4998
  • Fax: 646-434-0755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA SOLIMINE
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 646-480-7961