Healthcare Provider Details

I. General information

NPI: 1649059742
Provider Name (Legal Business Name): PROTERA HEALTH MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2023
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W BIG BEAVER RD STE 300
TROY MI
48084-4725
US

IV. Provider business mailing address

43313 WOODWARD AVE # 1174
BLOOMFIELD HILLS MI
48302-5007
US

V. Phone/Fax

Practice location:
  • Phone: 810-331-0939
  • Fax: 855-850-4055
Mailing address:
  • Phone: 772-359-9429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC MAKHNI
Title or Position: PRESIDENT
Credential: MD
Phone: 772-359-9429