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General NPI Number Information
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NPI Number | 1043496250
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE, P.C.
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 20307 W 12 MILE RD STE. 102
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City | SOUTHFIELD
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State | MI
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Zip | 48076-5407
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Country | US
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Telephone | 248-356-6661
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Fax | 248-356-6619
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Provider Business Mailing Address
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Address Line | 20307 W. 12 MILE STE. 102
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City | SOUTHFIELD
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State | MI
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Zip | 48076
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Country | US
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Telephone | 248-356-6661
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Fax | 248-356-6619
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK G. BELEN
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Credential | M.D.
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Telephone | 248-365-6661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 042374
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License Number State | MI
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