REVIVE SPORTS & SPINE MANAGEMENT (NPI# 1679195465) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679195465 |
| Entity Type | Organization |
| Organization Name | REVIVE SPORTS & SPINE MANAGEMENT |
| Practice Address |
27253 Van Dyke Ave Warren MI 48093-2858 |
| Mailing Address |
Po Box 7175 Dearborn MI 48121-7175 |
| Practice Telephone | 5864864520 |
| Mailing Telephone | 3137903998 |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2020-05-14 |
| Authorized Official Name | DR. HAROUN ALI FETTEH (DOCTOR/OWNER) |
| Authorized Official Telephone | 3137903998 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Street Address |
27253 VAN DYKE AVE |
| City | WARREN |
| State | MI |
| Zip Code | 48093-2858 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003210378 | Orthopedic Physical Therapy and Rehabilitation LLC | Clinic/Center | 27253 Van Dyke Ave, Warren, MI 48093-2858 | 2014-10-15 |
| 1508463712 | Michigan Laboratories LLC | Clinical Medical Laboratory | 27253 Van Dyke Ave, Warren, MI 48093-2858 | 2020-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023615986 | Toleka Regina Taylor | Nurse Anesthetist, Certified Registered | St. John Macomb Hospital, 11800 East 12 Mile Road, Warren, MI 48093 | 2020-10-05 |
| 1679112676 | Open Heart Communities | Case Management | 31310 Shaw Dr, Warren, MI 48093 | 2019-12-23 |
| 1538715636 | 3 Dove Medical Supplies | Durable Medical Equipment & Medical Supplies | 31201 Chicago Rd S Ste C101, Warren, MI 48093 | 2019-08-14 |
| 1568954600 | Schreiber Cardiology, P.C. | Internal Medicine | 8545 Common Rd Ste 150, Warren, MI 48093 | 2018-06-05 |
| 1730686197 | Lambro Seremetis | Social Worker | 12200 E. 12 Mile Road, Ste. 200, Warren, MI 48093 | 2018-04-11 |
| 1649775826 | Ridge Downs | Behavioral Analyst | 31201 Chicago Rd South, Suite C- 202, Warren, MI 48093 | 2018-03-28 |
| 1144722737 | Jessica Farraj | Occupational Therapist | 11800 E. 12 Mile Road, Warren, MI 48093 | 2018-02-28 |
| 1265930168 | Leah Hanrahan | Registered Nurse | 11700 Amberle Dr., Warren, MI 48093 | 2018-01-25 |
| 1598271553 | Pamela Marie Confer | Occupational Therapist | 11012 13 Mile Rd, Suite 200, Warren, MI 48093 | 2017-12-28 |
| 1831604347 | Kate Jeanne Szczepanski | Behavior Technician | 31200 Chicago Rd S, Warren, MI 48093 | 2017-12-06 |
| Find all providers in zip 48093 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518452010 | Endovascular Associates LLC | Clinic/Center | 8790 E Market St Ste 300, Warren, OH 44484-2360 | 2018-06-27 |
| 1194115402 | Lingareddy Devireddy Md PC | Clinic/Center | 11900 E 12 Mile Rd, Suite 103, Warren, MI 48093-3400 | 2015-01-26 |
| 1225381528 | Navaroli Medical | Clinic/Center | 1 New St, Warren, PA 16365-1551 | 2012-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684386 | True Women's Clinic of Grand Rapids, PC | Clinic/Center | 2144 E Paris Ave Se Ste 230, Grand Rapids, MI 49546-6111 | 2020-09-18 |
| 1497397202 | Kimberly Wallace Md PC | Clinic/Center | 12900 W 9 Mile Road, Oak Park, MI 48237 | 2019-10-14 |
| 1265081418 | Cherry Street Services Inc | Clinic/Center | 2125 Wrenwood St Sw Ofc Therapist, Wyoming, MI 49519-2362 | 2019-09-10 |
| 1023662079 | J & D Vision Inc | Clinic/Center | 41821 Garfield Rd, Clinton Twp, MI 48038-1965 | 2019-07-29 |
| 1649839945 | Michigan Institute of Sleep Disorders Pllc | Clinic/Center | 7108 Autumn Hill Dr, West Bloomfield, MI 48323-3904 | 2019-06-10 |
| 1447715131 | Ryan Klanseck, Do | Clinic/Center | 16986 Robbins Rd Ste 140, Grand Haven, MI 49417-2795 | 2019-02-06 |
| 1598242455 | Gratiot Advanced Center LLC | Clinic/Center | 7612 Gratiot Ave Ste 200, Detroit, MI 48213-2822 | 2018-07-24 |
| 1902356140 | Midmichigan Pain | Clinic/Center | 2305 Hawthorn Dr, Suite B, Mt Pleasant, MI 48858-1202 | 2016-10-12 |
| 1184085516 | Hester S Pernell Md Pllc | Clinic/Center | 24628 Ridgeview Dr, Farmington Hills, MI 48336-1905 | 2016-03-12 |
| 1275937625 | Innovative Anesthesia Services PC | Clinic/Center | 847 Parchment Dr Se Ste 105, Grand Rapids, MI 49546 | 2014-10-14 |
| Find all providers with the same taxonomy | ||||
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| 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.