# GRANDRAPIDS REGENERATIVE CENTER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013820059
- **Authorized official:** RYAN HIJAZI (OWNER)
- **Authorized official phone:** (617) 819-5841

## Contact information

- **Practice address:** 17220 W 12 MILE RD STE 129, SOUTHFIELD, MI 48076-2114
- **Practice address phone:** (617) 819-5841
- **Mailing address:** 17220 W 12 MILE RD STE 129, SOUTHFIELD, MI 48076-2114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/22/2026
- **Last updated:** 09/22/2026