Provider Demographics
NPI:1578692307
Name:STAT PAIN MANAGEMENT & REHABILITATION SPECIALTIES, LTD.
Entity Type:Organization
Organization Name:STAT PAIN MANAGEMENT & REHABILITATION SPECIALTIES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-434-6246
Mailing Address - Street 1:2883 HAWKS RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1318
Mailing Address - Country:US
Mailing Address - Phone:734-434-6246
Mailing Address - Fax:734-434-2307
Practice Address - Street 1:2883 HAWKS RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1318
Practice Address - Country:US
Practice Address - Phone:734-434-6246
Practice Address - Fax:734-434-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0007231172OtherAETNA PIN
MI540H104110OtherBLUE CROSS BLUE SHIELD
=========OtherHEALTHNET-TRICARE ID
MI540H104110OtherBLUE CROSS BLUE SHIELD