Healthcare Provider Details

I. General information

NPI: 1982637294
Provider Name (Legal Business Name): BACKOS PHYSICAL MEDICINE AND REHABILITATION CLINICE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27423 VAN DYKE AVE
WARREN MI
48093-2867
US

IV. Provider business mailing address

27423 VAN DYKE AVE
WARREN MI
48093-2867
US

V. Phone/Fax

Practice location:
  • Phone: 586-755-9855
  • Fax: 586-755-9880
Mailing address:
  • Phone: 586-755-9855
  • Fax: 586-755-9880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301048249
License Number StateMI

VIII. Authorized Official

Name: DR. ERIC BACKOS
Title or Position: OWNER
Credential: MD
Phone: 586-755-9855