Healthcare Provider Details

I. General information

NPI: 1982674784
Provider Name (Legal Business Name): HI CHUL SONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 HUBBARD DR SUITE 800
DEARBORN MI
48126-4258
US

IV. Provider business mailing address

17000 HUBBARD DR SUITE 800
DEARBORN MI
48126-4258
US

V. Phone/Fax

Practice location:
  • Phone: 313-240-7595
  • Fax: 313-240-7599
Mailing address:
  • Phone: 313-240-7595
  • Fax: 313-240-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301039922
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: