Provider Demographics
NPI:1811018575
Name:MICHIGAN SPINE AND REHAB CENTER
Entity Type:Organization
Organization Name:MICHIGAN SPINE AND REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-675-8127
Mailing Address - Street 1:18600 VAN HORN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-3828
Mailing Address - Country:US
Mailing Address - Phone:734-675-8127
Mailing Address - Fax:
Practice Address - Street 1:18600 VAN HORN RD
Practice Address - Street 2:SUITE D
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-3828
Practice Address - Country:US
Practice Address - Phone:734-675-8127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty