Healthcare Provider Details

I. General information

NPI: 1265236202
Provider Name (Legal Business Name): VANGUARD REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44932 FORD RD STE 423
CANTON MI
48187-3357
US

IV. Provider business mailing address

44932 FORD RD STE 423
CANTON MI
48187-3357
US

V. Phone/Fax

Practice location:
  • Phone: 313-580-1774
  • Fax: 313-800-7586
Mailing address:
  • Phone: 313-580-1774
  • Fax: 313-800-7586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA A MAFIAH
Title or Position: MANAGING EMPLOYEE
Credential: MD
Phone: 313-580-1774