Healthcare Provider Details

I. General information

NPI: 1245376268
Provider Name (Legal Business Name): MEDICAL REHAB, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19360 LIVERNOIS AVE
DETROIT MI
48221-1761
US

IV. Provider business mailing address

19360 LIVERNOIS AVE
DETROIT MI
48221-1761
US

V. Phone/Fax

Practice location:
  • Phone: 313-340-6000
  • Fax: 313-340-1777
Mailing address:
  • Phone: 313-340-6000
  • Fax: 313-340-1777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ABDUL HAQ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 313-340-6000