Organization
REVIVE SPORTS & SPINE MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAROUN ALI FETTEH DC (DOCTOR/OWNER)
(313) 790-3998
Entity
Organization
Contact information
Practice address
27253 VAN DYKE AVE, WARREN, MI 48093-2858
(586) 486-4520
Mailing address
PO BOX 7175, DEARBORN, MI 48121-7175
(313) 790-3998
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
05/14/2020
Last updated
05/14/2020
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