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General NPI Number Information
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NPI Number | 1013413236
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Entity Type | Organization
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Legal Business Name | SPORTS AND REGENERATIVE MEDICINE PLLC
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 170 W GENESEE ST
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City | FRANKENMUTH
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State | MI
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Zip | 48734-1305
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Country | US
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Telephone | 989-652-7344
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Fax | 989-652-7355
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Provider Business Mailing Address
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Address Line | 170 W GENESEE ST
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City | FRANKENMUTH
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State | MI
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Zip | 48734-1305
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Country | US
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Telephone | 989-652-7344
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Fax | 989-652-7355
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Authorized Official
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Title or Position | BILLING SPECIALIST
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Name | GAELEN AUGUST RAND
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Credential |
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Telephone | 989-652-7344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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