Basic Information
| Provider Information | |||||||||
| NPI: | 1417420886 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHEAST MICHIGAN REHAB & PAIN PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 890 WOLVERINE DR | ||||||||
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| City: | WOLVERINE LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483902377 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1070 ROSEWOOD ST | ||||||||
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| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481046250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344620340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2019 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | MERAM | ||||||||
| AuthorizedOfficialFirstName: | ANOTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2487220108 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.