Provider Demographics
NPI:1932449303
Name:REHABILITATION INSTITUTE OF MICHIGAN
Entity Type:Organization
Organization Name:REHABILITATION INSTITUTE OF MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:LULADAY
Authorized Official - Middle Name:WEGAYEHU
Authorized Official - Last Name:TEBEJE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:248-508-8047
Mailing Address - Street 1:19144 RED OAK LANE
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48193
Mailing Address - Country:US
Mailing Address - Phone:248-508-8047
Mailing Address - Fax:
Practice Address - Street 1:261 MACK AVE
Practice Address - Street 2:REHABILITATION INSTITUTE OF MICHIGAN
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-1203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704258722283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital