Provider Demographics
NPI:1982841672
Name:MICHAEL D REBOCK DO PLC
Entity Type:Organization
Organization Name:MICHAEL D REBOCK DO PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:REBOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-478-7734
Mailing Address - Street 1:28080 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 208 NORTH
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5966
Mailing Address - Country:US
Mailing Address - Phone:248-478-7734
Mailing Address - Fax:248-478-7789
Practice Address - Street 1:28080 GRAND RIVER AVE
Practice Address - Street 2:SUITE 208 NORTH
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5966
Practice Address - Country:US
Practice Address - Phone:248-478-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI323358011Medicaid
MI323358011Medicaid