Healthcare Provider Details

I. General information

NPI: 1780614909
Provider Name (Legal Business Name): WEST MICHIGAN REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/25/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 LINCOLN RD
HAMILTON MI
49419-9533
US

IV. Provider business mailing address

3491 LINCOLN RD
HAMILTON MI
49419-9533
US

V. Phone/Fax

Practice location:
  • Phone: 269-751-2150
  • Fax: 616-392-7959
Mailing address:
  • Phone: 269-751-2150
  • Fax: 616-392-7959

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: LEONARD R. FAZIO
Title or Position: PRESIDENT
Credential:
Phone: 269-751-2150