Healthcare Provider Details

I. General information

NPI: 1992159602
Provider Name (Legal Business Name): LEVEL 1 HEALTH SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14243 W 8 MILE RD
DETROIT MI
48235-1502
US

IV. Provider business mailing address

14243 W 8 MILE RD
DETROIT MI
48235-1502
US

V. Phone/Fax

Practice location:
  • Phone: 313-341-4444
  • Fax: 313-341-5677
Mailing address:
  • Phone: 313-341-4444
  • Fax: 313-341-5677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009756
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN KAKOZ
Title or Position: PRESIDENT
Credential:
Phone: 313-341-4444