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Organization
GRANDRAPIDS REGENERATIVE CENTER PLLC
Active
Organization
GRANDRAPIDS REGENERATIVE CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN HIJAZI (OWNER)
(617) 819-5841
Entity
Organization
Contact information
Practice address
17220 W 12 MILE RD STE 129, SOUTHFIELD, MI 48076-2114
(617) 819-5841
Mailing address
17220 W 12 MILE RD STE 129, SOUTHFIELD, MI 48076-2114
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
—
NULL
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
09/22/2026
Last updated
09/22/2026
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