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General NPI Number Information
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NPI Number | 1871794669
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Entity Type | Organization
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Legal Business Name | GREAT LAKES PHYSICAL MEDICINE AND REHABILITATION
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 3247 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-5951
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Country | US
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Telephone | 734-287-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 3247 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-5951
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Country | US
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Telephone | 734-287-3000
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Fax |
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. ANNE ABRAHAMSON
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Credential | M.D.
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Telephone | 313-304-4818
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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 | 078199
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License Number State | MI
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