MEDICARE: PREMIER MEDICAL AND REHABILITATION GROUP

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1871812628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER MEDICAL AND REHABILITATION GROUP

Provider Business Mailing Address
First Line	:	30500 NORTHWESTERN HWY STE 316C
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3178
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 N SAGINAW ST
Second Line	:
City	:	HOLLY
State	:	MI
Zip	:	48442-1380
Country	:	US
Telephone Number	:	248-935-6646
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	BORIS BERKOVICH
Credential	:
Telephone Number	:	248-935-6646

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	05/19/2010

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