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General NPI Number Information
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NPI Number | 1154177541
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Entity Type | Organization
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Legal Business Name | PROTERA HEALTH MEDICAL OF MICHIGAN PC
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 801 W BIG BEAVER RD STE 300
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City | TROY
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State | MI
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Zip | 48084-4725
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Country | US
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Telephone | 810-331-0939
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Fax | 855-850-4055
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Provider Business Mailing Address
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Address Line | 43313 WOODWARD AVE # 1174
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-5007
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Country | US
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Telephone | 810-331-0939
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Fax | 855-850-4055
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Authorized Official
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Title or Position | OWNER
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Name | ERIC MAKHNI
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Credential | MD
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Telephone | 810-331-0939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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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 | 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 #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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