1093047573 NPI number — MAGNUM REHAB SERVICES,INC.

Table of content: MRS. DIANE ALANA DICARLO LA.C, LMT (NPI 1063727949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093047573 NPI number — MAGNUM REHAB SERVICES,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAGNUM REHAB SERVICES,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093047573
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 GOLFVIEW DR
Provider Second Line Business Mailing Address:
108
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084-3930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-559-2200
Provider Business Mailing Address Fax Number:
248-559-2298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24123 GREENFIELD RD
Provider Second Line Business Practice Location Address:
305
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48075-3125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-559-2200
Provider Business Practice Location Address Fax Number:
248-559-2298
Provider Enumeration Date:
02/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BARANWAL
Authorized Official First Name:
KRISHNA
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
248-559-2200

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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