Provider Demographics
NPI:1558433136
Name:REHABILITATION ASSOCIATES OF MIDMICHIGAN P L C
Entity Type:Organization
Organization Name:REHABILITATION ASSOCIATES OF MIDMICHIGAN P L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SZAJENKO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:989-631-9267
Mailing Address - Street 1:555 W WACKERLY ST
Mailing Address - Street 2:#3825
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4722
Mailing Address - Country:US
Mailing Address - Phone:989-631-9267
Mailing Address - Fax:989-839-0629
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:#3825
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4722
Practice Address - Country:US
Practice Address - Phone:989-631-9267
Practice Address - Fax:989-839-0629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3383068Medicaid
MI4187893Medicaid
MIG54165Medicare UPIN
MIOM42070 003Medicare ID - Type UnspecifiedSZAJENKO
MIOM42070 001Medicare ID - Type UnspecifiedBERGEON
MI3383068Medicaid