Organization
OCCUPATIONAL AND REHABAILITATION MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IFEYINWA ILECHUKWU MD (MEDICAL DIRECTOR)
31333885939
Entity
Organization
Contact information
Practice address
25650 OUTER DR, STE 500, LINCOLN PARK, MI 48146-2096
(313) 388-5939
(313) 388-5969
Mailing address
25650 OUTER DR, STE 500, LINCOLN PARK, MI 48146-2096
(313) 338-5939
(313) 388-5969
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
II072967
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4695533
—
MI
Enumeration date
06/08/2006
Last updated
02/04/2009
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