Provider Demographics
NPI:1811187149
Name:REHAB MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:REHAB MEDICAL SPECIALIST
Other - Org Name:HART LAND NH.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INTERNAL MEDICINE/GERIATRICS
Authorized Official - Prefix:DR
Authorized Official - First Name:BNAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZOKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1248-663-5353
Mailing Address - Street 1:24901 NORTHWESTERN HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2205
Mailing Address - Country:US
Mailing Address - Phone:124-866-3535
Mailing Address - Fax:124-835-7324
Practice Address - Street 1:24901 NORTHWESTERN HWY STE 205
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2205
Practice Address - Country:US
Practice Address - Phone:124-866-3535
Practice Address - Fax:124-835-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082048281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital