MEDICARE: ADVANTAGE PROFESSIONAL REHAB. SERVICES LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	5305035066	MI

General Provider Information

NPI Number	:	1154698439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE PROFESSIONAL REHAB. SERVICES LTD

Provider Business Mailing Address
First Line	:	6701 STONEBRIDGE CT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3268
Country	:	US
Telephone Number	:	248-240-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	23411 JOHN R RD
Second Line	:
City	:	HAZEL PARK
State	:	MI
Zip	:	48030-1404
Country	:	US
Telephone Number	:	248-544-4181
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUHAMMAD SAEED TARIQ
Credential	:	RPT
Telephone Number	:	248-240-4111

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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