Provider Demographics
NPI:1417420886
Name:SOUTHEAST MICHIGAN REHAB & PAIN PLLC
Entity Type:Organization
Organization Name:SOUTHEAST MICHIGAN REHAB & PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANOTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-722-0108
Mailing Address - Street 1:890 WOLVERINE DR
Mailing Address - Street 2:
Mailing Address - City:WOLVERINE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-2377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1070 ROSEWOOD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6250
Practice Address - Country:US
Practice Address - Phone:734-462-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty