Healthcare Provider Details

I. General information

NPI: 1154245991
Provider Name (Legal Business Name): BODYREFORMMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 RUE DEMERS
WEST BLOOMFIELD MI
48323-2285
US

IV. Provider business mailing address

4480 RUE DEMERS
WEST BLOOMFIELD MI
48323-2285
US

V. Phone/Fax

Practice location:
  • Phone: 248-217-1030
  • Fax:
Mailing address:
  • Phone: 248-217-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY T KONJA
Title or Position: MANAGER
Credential: DO
Phone: 248-410-6398