1093287971 NPI number — PREMIER PHYSICAL MEDICINE AND REHABILITATION OF MICHIGAN, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093287971 NPI number — PREMIER PHYSICAL MEDICINE AND REHABILITATION OF MICHIGAN, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER PHYSICAL MEDICINE AND REHABILITATION OF MICHIGAN, P.C.
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:
6
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:
1093287971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33717 WOODWARD AVE # 416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-0913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-809-1227
Provider Business Mailing Address Fax Number:
248-809-1228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 W 13 MILE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48073-6712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-275-8571
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
DESANTIS
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
248-809-1227

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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