Provider Demographics
NPI:1962442152
Name:BPS REHABILITATION SPECIALIST PC
Entity Type:Organization
Organization Name:BPS REHABILITATION SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:STATHAKIOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:810-877-7375
Mailing Address - Street 1:3400 FLECKENSTEIN DR S 1
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-877-7370
Mailing Address - Fax:810-230-9338
Practice Address - Street 1:3400 FLECKENSTEIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3042
Practice Address - Country:US
Practice Address - Phone:810-877-7370
Practice Address - Fax:810-230-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P03860Medicare PIN
MI0P03870Medicare PIN