MEDICARE: SOUTHFIELD REHABILITATION COMPANY

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician
2	2471C3401X	Computed Tomography Radiologic Technologist
3	2084N0400X	Neurology Physician
4	261QA1903X	Ambulatory Surgical Clinic/Center	630013	MI
5	367500000X	Certified Registered Nurse Anesthetist
6	207XS0106X	Orthopaedic Hand Surgery Physician
7	261QR0208X	Mobile Radiology Clinic/Center
8	282N00000X	General Acute Care Hospital
9	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
10	2085R0202X	Diagnostic Radiology Physician
11	282N00000X	General Acute Care Hospital	630013	MI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00127	OTHER		BCBS OF MICHIGAN
2	007389	OTHER	MI	MIDWEST HEALTH PLAN
3	135598501	OTHER		U.S. DEPARTMENT OF LABOR
4	34692	OTHER	MI	HEALTH PLAN OF MICHIGAN
5	00127	OTHER	MI	BLUE CARE NETWORK
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1031384	OTHER	MI	MCLAREN HEALTH PLAN
9	5968608	OTHER	MI	AETNA

NPI Number	:	1790785095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHFIELD REHABILITATION COMPANY

Provider Business Mailing Address
First Line	:	22401 FOSTER WINTER DR
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-3724
Country	:	US
Telephone Number	:	248-423-5198
Fax Number	:	248-423-5186

Provider Business Practice Location Address
First Line	:	22401 FOSTER WINTER DRIVE
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48075-3724
Country	:	US
Telephone Number	:	248-423-5100
Fax Number	:	248-423-5199

Authorized Official
Title or Position	:	MEDICAL STAFF COORDINATOR
Name	:	MRS. RONDA SELEY
Credential	:
Telephone Number	:	248-423-5198

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	02/13/2026

22401 FOSTER WINTER DRIVE
SOUTHFIELD, MI
48075-3724

Practice Phone: 248-423-5100
Practice Fax: 248-423-5195

22401 FOSTER WINTER DR
SOUTHFIELD, MI
48075-3724