# MD REGENERATION, PLLC

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

## Provider details

- **NPI number:** 1780183186
- **Authorized official:** MACKENZIE JENNINGS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (617) 454-4916

## Contact information

- **Practice address:** 333 W 7TH ST STE 100, ROYAL OAK, MI 48067-2510
- **Practice address phone:** (248) 561-0602
- **Mailing address:** 41000 WOODWARD AVE STE 350, BLOOMFIELD, MI 48304-5092
- **Mailing address phone:** (248) 404-0501

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 5101020789 | MI | Yes |

## Other

- **Enumeration date:** 02/12/2018
- **Last updated:** 08/23/2019