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General NPI Number Information
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NPI Number | 1225146657
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Entity Type | Organization
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Legal Business Name | MIDWEST PHYSICAL MEDICINE AND REHABILITATION PLLC
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 14555 LEVAN RD SUITE 314
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City | LIVONIA
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State | MI
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Zip | 48154-5083
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Country | US
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Telephone | 734-542-1970
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Fax | 248-614-9756
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Provider Business Mailing Address
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Address Line | PO BOX 285
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City | TROY
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State | MI
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Zip | 48099-0285
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Country | US
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Telephone | 734-542-1970
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Fax | 248-614-9756
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MONICA GREEN
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Credential | M.D.
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Telephone | 734-542-1970
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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 | 4301076422
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License Number State | MI
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