Provider Demographics
NPI:1275710725
Name:A ONE MICHIGAN REHAB P.C.
Entity Type:Organization
Organization Name:A ONE MICHIGAN REHAB P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAQAR
Authorized Official - Middle Name:KHALIP
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-498-7100
Mailing Address - Street 1:18161 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3219
Mailing Address - Country:US
Mailing Address - Phone:586-498-7100
Mailing Address - Fax:586-498-7101
Practice Address - Street 1:18161 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3219
Practice Address - Country:US
Practice Address - Phone:586-498-7100
Practice Address - Fax:586-498-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430-1068827174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty