Basic Information
Provider Information | |||||||||
NPI: | 1033855440 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PARAMOUNT REHABILITATION SERVICES, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | PARAMOUNT REHABILITATION SERVICES, PC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 202 PINE ST | ||||||||
Address2: |   | ||||||||
City: | CHESANING | ||||||||
State: | MI | ||||||||
PostalCode: | 486161252 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9893232090 | ||||||||
FaxNumber: | 9893233991 | ||||||||
Practice Location | |||||||||
Address1: | 202 PINE ST | ||||||||
Address2: |   | ||||||||
City: | CHESANING | ||||||||
State: | MI | ||||||||
PostalCode: | 486161252 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9893232090 | ||||||||
FaxNumber: | 9893233991 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/09/2022 | ||||||||
LastUpdateDate: | 06/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MALEWAR | ||||||||
AuthorizedOfficialFirstName: | SUNIL | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | PARAMOUNT REHABILITATION SERVICES | ||||||||
AuthorizedOfficialTelephone: | 9898919800 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | PARAMOUNT REHABILITATION SERVICES | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/24/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251H1200X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | 2251P0200X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 225XH1200X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225XP0019X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | 225XP0200X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | 2355S0801X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | 225100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 404679870 | 05 | MI |   | MEDICAID | 30738 | 01 | MI | BLUE CROSS AND BLUE SHIELD OF MICHIGAN | OTHER | 30738 | 01 | MI | BLUE CARE NETWORK | OTHER | 236819 | 01 | MI | MEDICARE PIN | OTHER |