Healthcare Provider Details

I. General information

NPI: 1760166821
Provider Name (Legal Business Name): IEP - POST ACUTE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 ROBINSON RD
JACKSON MI
49203-2538
US

IV. Provider business mailing address

PO BOX 675460
DETROIT MI
48267-5460
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-5140
  • Fax: 517-787-0722
Mailing address:
  • Phone: 248-536-2127
  • Fax: 248-893-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID HALL
Title or Position: OWNER
Credential: MD
Phone: 248-536-2127