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General NPI Number Information
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NPI Number | 1265236202
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Entity Type | Organization
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Legal Business Name | VANGUARD REHAB
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 42807 FORD RD STE 423
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City | CANTON
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State | MI
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Zip | 48187-3357
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Country | US
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Telephone | 313-580-1774
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Fax | 313-800-7586
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Provider Business Mailing Address
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Address Line | 42807 FORD RD STE 423
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City | CANTON
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State | MI
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Zip | 48187-3357
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Country | US
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Telephone | 313-580-1774
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Fax | 313-800-7586
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Authorized Official
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Title or Position | MANAGING EMPLOYEE
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Name | MELISSA A MAFIAH
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Credential | MD
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Telephone | 313-580-1774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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