# ELITE SPORTS & REGENERATIVE MEDICINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elite Sports & Regenerative Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619863933
- **Authorized official:** DR. MOHAMMAD IBRAHIM DO (MANAGER)
- **Authorized official phone:** (313) 764-0088

## Contact information

- **Practice address:** 1022 N TELEGRAPH RD STE 2, DEARBORN, MI 48128-1622
- **Practice address phone:** (313) 764-0088
- **Practice address fax:** (313) 254-3586
- **Mailing address:** 1022 N TELEGRAPH RD STE 2, DEARBORN, MI 48128-1622
- **Mailing address phone:** (313) 764-0088
- **Mailing address fax:** (313) 254-3586

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2025
- **Last updated:** 06/13/2025