Provider Demographics
NPI:1093287971
Name:PREMIER PHYSICAL MEDICINE AND REHABILITATION OF MICHIGAN, P.C.
Entity Type:Organization
Organization Name:PREMIER PHYSICAL MEDICINE AND REHABILITATION OF MICHIGAN, P.C.
Other - Org Name:PREMIER PM&R
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-809-1227
Mailing Address - Street 1:33717 WOODWARD AVE # 416
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-0913
Mailing Address - Country:US
Mailing Address - Phone:248-809-1227
Mailing Address - Fax:248-809-1228
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-275-8571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty