Provider Demographics
NPI:1093869604
Name:NORTHERN MICHIGAN REHABILITATION SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:NORTHERN MICHIGAN REHABILITATION SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-348-1995
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-0034
Mailing Address - Country:US
Mailing Address - Phone:231-348-1995
Mailing Address - Fax:231-347-3223
Practice Address - Street 1:3916 CHARLEVOIX AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9722
Practice Address - Country:US
Practice Address - Phone:231-348-1995
Practice Address - Fax:231-347-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P40400Medicare PIN