GREAT LAKES PAIN AND INJURY CENTER (NPI# 1548706534) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548706534 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES PAIN AND INJURY CENTER |
| Practice Address |
15565 Northland Dr. Suite 103 W Southfield MI 48075 |
| Practice Telephone | 2488092094 |
| Mailing Telephone | 2488092094 |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2017-01-13 |
| Authorized Official Name | JAIMON JACOB (PHYSICAL THERAPIST) |
| Authorized Official Telephone | 2488092094 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
5501013218 | MI | Ambulatory Health Care Facilities |
| Street Address |
15565 NORTHLAND DR. SUITE 103 W |
| City | SOUTHFIELD |
| State | MI |
| Zip Code | 48075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083714489 | Bethharold Durable Medical Equipment | Durable Medical Equipment & Medical Supplies | 15565 Northland Dr., Suite 403e, Southfield, MI 48075 | 2006-09-25 |
| 1568714731 | Star Rehab. LLC | Health Maintenance Organization | 15565 Northland Dr., Suite 205 E., Southfield, MI 48075 | 2012-10-11 |
| 1730431214 | Advantage Professional Rehab Services Ltd | Point of Service | 15565 Northland Dr., Suite 208 E., Southfield, MI 48075 | 2012-10-09 |
| 1871843623 | Ashfaq Ahmed | Physical Therapist | 15565 Northland Dr., 205 E, Southfield, MI 48075-5358 | 2012-09-19 |
| 1558686048 | Ace Private Care,llc | Home Health | 15565 Northland Dr., Suite 704 W, Southfield, MI 48075 | 2010-03-29 |
| 1508936352 | Rasheed Alade | Physical Therapist | 15565 Northland Dr., Suite 506w, Southfield, MI 48075-5307 | 2006-11-09 |
| 1598834467 | Excel Physical Therapy Services Inc | Occupational Therapist | 15565 Northland Dr., Suite 506west, Southfield, MI 48075-5307 | 2006-11-07 |
| 1578656229 | Bethharold Private Duty Care Inc. | Nursing Care | 15565 Northland Dr., Suite 403e, Southfield, MI 48075-5308 | 2006-10-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851900054 | K&b Medical Wigs, LLC | Durable Medical Equipment & Medical Supplies | 16250 Northland Dr. Ste 221, Southfield, MI 48075 | 2020-07-24 |
| 1790300390 | Julian Jeberaeel | Radiology | 2250 Providence, Southfield, MI 48075 | 2020-06-10 |
| 1265056410 | Husein Yusuf Husein | Podiatrist | Ascension Providence Hospital Southfield Campus, 16001 W. Nine Mile Rd. Depaul 2nd Floor, Southfield, Mi, MI 48075 | 2020-06-03 |
| 1952945420 | Paris Straughter | Nurse Practitioner | 18438 Onyx St, Southfield, MI 48075 | 2019-10-29 |
| 1811467657 | Medicine Man Medical, Pllc | Physical Medicine & Rehabilitation | 25130 Southfield Road, Suite #210, Southfield, MI 48075 | 2018-12-04 |
| 1447725528 | Rommel Ramos Perez | Physical Therapist | 26017 Greenfield Rd., Southfield, MI 48075 | 2018-10-04 |
| 1073009627 | Jacqueline Venora Goodgame | Licensed Practical Nurse | 4000 Town Ctr, Southfield, MI 48075 | 2018-07-06 |
| 1043712532 | Hollie Marie Maltese | Physical Therapy Assistant | 22255 Greenfiled 118, Southfield, MI 48075 | 2018-03-01 |
| 1932601481 | Katie Marie Mccormack | Occupational Therapist | 16001 West Nine Mile Rd., Southfield, MI 48075 | 2018-03-01 |
| 1801304241 | Absolute Hc LLC | Physical Therapist | 23461 Greenfield Rd Ste 200b, Southfield, MI 48075 | 2018-01-19 |
| Find all providers in zip 48075 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578176269 | Pro-line Physical Therapy, LLC | Clinic/Center | 25899 W 12 Mile Rd Ste 335, Southfield, MI 48034-8343 | 2020-08-24 |
| 1043864622 | Marina Physical Therapy | Clinic/Center | 17515 W 9 Mile Rd Ste 180, Southfield, MI 48075-4400 | 2019-07-31 |
| 1770149700 | 411 Help II | Clinic/Center | 27207 Lahser Rd Ste 106, Southfield, MI 48034-2168 | 2019-05-15 |
| 1366938268 | Aa Physical Therapy & Rehabilitation, LLC | Clinic/Center | 16250 Northland Dr Ste 350, Southfield, MI 48075-5228 | 2018-07-03 |
| 1689166894 | Recore Rehabilitation Services | Clinic/Center | 25899 W 12 Mile Rd # 340, Southfield, MI 48034 | 2018-06-04 |
| 1972092179 | Superior Physical Therapy | Clinic/Center | 27209 Lahser Rd Ste 130, Southfield, MI 48034-8401 | 2018-05-03 |
| 1578063749 | El-abbadi Healthcare Center | Clinic/Center | 27403 Lahser Rd, Southfield, MI 48034 | 2018-02-14 |
| 1336647700 | Theraflex Physical Therapy LLC | Clinic/Center | 20180 W 12 Mile Rd Ste 100, Southfield, MI 48076-5412 | 2018-01-31 |
| 1073011573 | United Wellness Physical Therapy, LLC | Clinic/Center | 20755 Greenfield Rd Ste 800, Southfield, MI 48075-5410 | 2018-01-30 |
| 1043723430 | Shalom Therapy Services LLC | Clinic/Center | 26206 W 12 Mile Rd Ste 204, Southfield, MI 48034-8500 | 2017-11-08 |
| Find all providers in SOUTHFIELD | ||||
| City | SOUTHFIELD |
| Zip Code | 48075 |
Please comment or provide details below to improve the information on GREAT LAKES PAIN AND INJURY CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.