Provider Demographics
NPI:1093133365
Name:REGIONAL MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:REGIONAL MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-321-6612
Mailing Address - Street 1:30600 TELEGRAPH RD
Mailing Address - Street 2:SUITE 1131
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4530
Mailing Address - Country:US
Mailing Address - Phone:248-321-6612
Mailing Address - Fax:
Practice Address - Street 1:30600 TELEGRAPH RD
Practice Address - Street 2:SUITE 1131
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4530
Practice Address - Country:US
Practice Address - Phone:248-321-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010109522081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty