Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 273Y00000X | Rehabilitation Unit | | 82-0040 | MICHIGAN | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 010900 | OTHER | MICHIGAN | E21 CARELINK NETWO |
| 2 | 200 | OTHER | MICHIGAN | OTHER: BCBSM |
| 3 | 266564000 | OTHER | MICHIGAN | E20 COMM BEHAVIOR |
| 4 | 369003700 | OTHER | MICHIGAN | J52 US DEPT/LABOR |
| 5 | 383404533002 | OTHER | MICHIGAN | G02 CHAMPVA CENTER |
| 6 | 000000001537 | OTHER | MICHIGAN | E04 CAPE HEALTH |
| 7 | 55150 | OTHER | MICHIGAN | H61 TOTAL HLTH CAR |
| 8 | 0726021 | OTHER | MICHIGAN | H71 AETNA HMO |
| 9 | 14599 | OTHER | MICHIGAN | E22 PERSON CENTER |
| 10 | 383404533002 | OTHER | MICHIGAN | G03 TRICARE |
| 11 | 23-T135 | MEDICARE ID-TYPE UNSPECIFIED | MICHIGAN | MEDICARE |
| 12 | 341420303 | OTHER | MICHIGAN | J23 MEADOWBROOK |
| 13 | 49882 | OTHER | MICHIGAN | H45 OMNICARE |
| 14 | 121143 | OTHER | MICHIGAN | H08 CARE CHOICES HMO |
| 15 | 121143 | OTHER | MICHIGAN | H50 PREFERRED CHOI |
| 16 | 383404533002 | OTHER | MICHIGAN | G01 TRI-CARE |
| 17 | 30 2774932 | MEDICAID | MICHIGAN | |