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General NPI Number Information
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NPI Number | 1790253417
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Entity Type | Organization
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Legal Business Name | MICHIGAN SPINE AND SPORTS MANAGEMENT P.C.
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Dates
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Enumeration Date | 11/12/2018
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 24681 NORTHWESTERN HWY STE 103
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City | SOUTHFIELD
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State | MI
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Zip | 48075-2317
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Country | US
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Telephone | 248-809-9286
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7028
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City | DEARBORN
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State | MI
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Zip | 48121-7028
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Country | US
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Telephone | 313-790-3998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HAROUN FETTEH
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Credential | D.C.
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Telephone | 313-790-3998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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