Provider Demographics
NPI:1720188584
Name:MEDSTAR REHABILITATION INC.
Entity Type:Organization
Organization Name:MEDSTAR REHABILITATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEERA
Authorized Official - Middle Name:INDER
Authorized Official - Last Name:THAWANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-844-0800
Mailing Address - Street 1:2050 N. HAGGERTY RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187
Mailing Address - Country:US
Mailing Address - Phone:734-844-0800
Mailing Address - Fax:734-844-0808
Practice Address - Street 1:2050 N. HAGGERTY RD
Practice Address - Street 2:SUITE 280
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-844-0800
Practice Address - Fax:734-844-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
13468OtherMCARE
CK4098OtherRAILROAD MEDICARE
611600700OtherU.S. DEPARTMENT OF LABOR
MI0N67360Medicare PIN
CK4098OtherRAILROAD MEDICARE