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General NPI Number Information
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NPI Number | 1881971745
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Entity Type | Organization
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Legal Business Name | MICHIGAN MEDICAL REHAB
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 12000 INKSTER RD
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City | ROMULUS
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State | MI
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Zip | 48174-2841
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Country | US
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Telephone | 313-790-4010
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Fax | 734-307-3585
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Provider Business Mailing Address
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Address Line | 18932 HALLETT CT
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City | ROMULUS
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State | MI
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Zip | 48174-9315
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Country | US
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Telephone | 313-320-5025
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Fax | 734-282-1551
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LORETTA JAMIESON
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Credential |
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Telephone | 313-790-4010
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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 |
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License Number State |
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