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General NPI Number Information
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NPI Number | 1700833563
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Entity Type | Organization
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Legal Business Name | MEDICAL REHABILITATION GROUP PC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 4632 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8067
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Country | US
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Telephone | 810-606-7181
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Fax | 810-606-5803
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Provider Business Mailing Address
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Address Line | 4632 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8067
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Country | US
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Telephone | 810-606-7181
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Fax | 810-606-5803
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. RICHARD JAY KOVAN
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Credential | M.D.
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Telephone | 810-606-7181
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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 | 4301055356
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License Number State | MI
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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 | 4301072856
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101011977
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 5101011645
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License Number State | MI
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