Provider Demographics
NPI:1013413236
Name:SPORTS AND REGENERATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:SPORTS AND REGENERATIVE MEDICINE PLLC
Other - Org Name:STEM HEALTH SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JONDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-652-7344
Mailing Address - Street 1:170 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1305
Mailing Address - Country:US
Mailing Address - Phone:899-652-7344
Mailing Address - Fax:989-652-7355
Practice Address - Street 1:170 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1305
Practice Address - Country:US
Practice Address - Phone:989-652-7344
Practice Address - Fax:989-652-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207QS0010X
MI207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275290017OtherNPI
MI1255861738OtherNPI
MI1912312489OtherNPI
MI1740723170OtherNPI