Provider Demographics
NPI:1750836946
Name:UNIVERSAL REHAB & PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:UNIVERSAL REHAB & PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TASADAQ
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:313-477-9545
Mailing Address - Street 1:901 W GRAND BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2353
Mailing Address - Country:US
Mailing Address - Phone:313-477-9545
Mailing Address - Fax:313-993-9007
Practice Address - Street 1:901 W GRAND BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2353
Practice Address - Country:US
Practice Address - Phone:313-477-9545
Practice Address - Fax:313-993-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health