# KERTIA BLACK MD BOARD CERTIFIED IN REHABILITATION MEDICINE

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

## Provider details

- **NPI number:** 1902422363
- **Authorized official:** MR. KERTIA BLACK MD (OWNER)
- **Authorized official phone:** (248) 910-7018

## Contact information

- **Practice address:** 27725 RAINBOW CIR, LATHRUP VILLAGE, MI 48076-3238
- **Practice address phone:** (248) 910-7018
- **Practice address fax:** (248) 557-5409
- **Mailing address:** 27725 RAINBOW CIR, LATHRUP VILLAGE, MI 48076-3238
- **Mailing address phone:** (248) 910-7018
- **Mailing address fax:** (248) 557-5409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/22/2020
- **Last updated:** 06/22/2020