Provider Demographics
NPI:1831527175
Name:MEDICAL REHABILITATION PHYSICIANS
Entity type:Organization
Organization Name:MEDICAL REHABILITATION PHYSICIANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:BLEIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-772-1609
Mailing Address - Street 1:2480 W CAMPUS DR
Mailing Address - Street 2:STE 500
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-5414
Mailing Address - Country:US
Mailing Address - Phone:989-772-1609
Mailing Address - Fax:989-772-6279
Practice Address - Street 1:6079 W MAPLE RD
Practice Address - Street 2:#100B
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2283
Practice Address - Country:US
Practice Address - Phone:248-851-7246
Practice Address - Fax:248-851-7223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253934363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704253934OtherSTATE LICENSE