Healthcare Provider Details

I. General information

NPI: 1083314124
Provider Name (Legal Business Name): GREATER HEALTH CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17515 W 9 MILE RD
SOUTHFIELD MI
48075-4403
US

IV. Provider business mailing address

17515 W 9 MILE RD
SOUTHFIELD MI
48075-4403
US

V. Phone/Fax

Practice location:
  • Phone: 248-667-8977
  • Fax: 248-905-3343
Mailing address:
  • Phone: 248-667-8977
  • Fax: 248-905-3343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARRION BURTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 248-667-8977