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General NPI Number Information
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NPI Number | 1568714731
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Entity Type | Organization
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Legal Business Name | STAR REHAB. LLC
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 15565 NORTHLAND DR. SUITE 205 E.
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-443-7202
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Fax | 248-443-7232
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Provider Business Mailing Address
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Address Line | 15565 NORTHLAND DR. SUITE. 205 E.
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City | SOUTHFIELD
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State | MI
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Zip | 48075
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Country | US
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Telephone | 248-443-7202
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Fax | 248-443-7232
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ASHFAQ AHMED
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Credential | B.SC. RPT
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Telephone | 248-443-7202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 225100000X
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License Number State | MI
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