=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932449303
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REHABILITATION INSTITUTE OF MICHIGAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2013
-----------------------------------------------------
Last Update Date | 02/22/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 261 MACK AVE REHABILITATION INSTITUTE OF MICHIGAN
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-745-1203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19144 RED OAK LANE
-----------------------------------------------------
City | BROWNSTOWN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-508-8047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MS. LULADAY WEGAYEHU TEBEJE
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 248-508-8047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283X00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital
-----------------------------------------------------
License Number | 4704258722
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------