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General NPI Number Information
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NPI Number | 1154245991
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Entity Type | Organization
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Legal Business Name | BODYREFORMMD
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 4480 RUE DEMERS
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2285
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Country | US
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Telephone | 248-217-1030
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Fax |
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Provider Business Mailing Address
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Address Line | 4480 RUE DEMERS
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-2285
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Country | US
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Telephone | 248-217-1030
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ANTHONY T KONJA
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Credential | DO
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Telephone | 248-410-6398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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