Provider Demographics
NPI:1558014878
Name:ADVANCED BODY MEDICAL PC
Entity Type:Organization
Organization Name:ADVANCED BODY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:KENDAL
Authorized Official - Last Name:LORANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-740-5148
Mailing Address - Street 1:125 W COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2719
Mailing Address - Country:US
Mailing Address - Phone:734-697-4244
Mailing Address - Fax:734-697-8102
Practice Address - Street 1:125 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-2719
Practice Address - Country:US
Practice Address - Phone:734-697-4244
Practice Address - Fax:734-697-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-27
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty