Healthcare Provider Details

I. General information

NPI: 1326213315
Provider Name (Legal Business Name): REHAB ALLIANCE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST 6B
DETROIT MI
48201-2153
US

IV. Provider business mailing address

3319 GREENFIELD RD # 360
DEARBORN MI
48120-1212
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-2609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301080335
License Number StateMI

VIII. Authorized Official

Name: FLORA DEAN
Title or Position: MD
Credential: MD
Phone: 313-580-7949