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General NPI Number Information
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NPI Number | 1134311954
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Entity Type | Organization
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Legal Business Name | DETROIT INSTITUTE OF PHYSICAL MEDICINE & REHABILITATION, PC
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 25811 WEST TWELVE MILE ROAD
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 248-358-5830
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Fax | 248-358-3425
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Provider Business Mailing Address
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Address Line | 25811 WEST TWELVE MILE ROAD
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City | SOUTHFIELD
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State | MI
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Zip | 48034
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Country | US
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Telephone | 248-358-5830
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Fax | 248-358-3425
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN EDWARD NEWMAN
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Credential | MD
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Telephone | 248-358-5830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BN0253815
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | BN0253827
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License Number State | MI
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