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General NPI Number Information
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NPI Number | 1992565105
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Entity Type | Organization
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Legal Business Name | SOUTHFIELD REGENERATIVE MEDICAL CENTER PLLC
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 04/05/2024
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Provider Practice Location Address
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Address Line | 17220 W 12 MILE RD STE 200
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2141
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Country | US
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Telephone | 313-284-9433
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Fax | 313-284-3180
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Provider Business Mailing Address
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Address Line | 17220 W 12 MILE RD STE 205
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2114
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Country | US
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Telephone | 313-284-9433
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Fax | 313-284-3180
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Authorized Official
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Title or Position | OWNER
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Name | RYAN HIJAZI
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Credential | DO
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Telephone | 313-284-9433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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