Provider Demographics
NPI:1710355482
Name:MICHIGAN CENTER FOR REGENERATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:MICHIGAN CENTER FOR REGENERATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:NABITY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:248-259-0066
Mailing Address - Street 1:109 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3152
Mailing Address - Country:US
Mailing Address - Phone:248-216-1008
Mailing Address - Fax:248-841-1843
Practice Address - Street 1:109 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-3152
Practice Address - Country:US
Practice Address - Phone:248-216-1008
Practice Address - Fax:855-711-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010833702081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty