Provider Demographics
NPI:1134168305
Name:REHABILITATION MEDICINE PHYSICIANS PC
Entity type:Organization
Organization Name:REHABILITATION MEDICINE PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTOCILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-351-8123
Mailing Address - Street 1:3960 PATIENT CARE WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4275
Mailing Address - Country:US
Mailing Address - Phone:517-351-8123
Mailing Address - Fax:517-351-1352
Practice Address - Street 1:3960 PATIENT CARE WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4275
Practice Address - Country:US
Practice Address - Phone:517-351-8123
Practice Address - Fax:517-351-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICV405064208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0331111OtherBCBSM
MI25008734OtherRAILROAD MEDICARE
MIG13408Medicare UPIN
MI25008734OtherRAILROAD MEDICARE