Provider Demographics
NPI:1881971745
Name:MICHIGAN MEDICAL REHAB
Entity type:Organization
Organization Name:MICHIGAN MEDICAL REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-790-4010
Mailing Address - Street 1:18932 HALLETT CT
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-9315
Mailing Address - Country:US
Mailing Address - Phone:313-320-5025
Mailing Address - Fax:734-282-1551
Practice Address - Street 1:12000 INKSTER RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-2841
Practice Address - Country:US
Practice Address - Phone:313-790-4010
Practice Address - Fax:734-307-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization