Healthcare Provider Details

I. General information

NPI: 1477722585
Provider Name (Legal Business Name): SOUTHFIELD REHABILITATION COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date: 06/04/2008
Reactivation Date: 09/03/2008

III. Provider practice location address

11012 THIRTEEN MILE ROAD SUITE 111
WARREN MI
48093-2546
US

IV. Provider business mailing address

PO BOX 674073
DETROIT MI
48267-4073
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-8470
  • Fax: 586-558-8481
Mailing address:
  • Phone: 586-582-0864
  • Fax: 586-576-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number50C656
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number630013
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301046061
License Number StateMI

VIII. Authorized Official

Name: DR. EDWARD F. BURKE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 248-423-5111