Organization
EAST DETROIT PAIN AND REHAB PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY LEE MATFUS M.D. (OWNER)
(201) 294-1010
Entity
Organization
Contact information
Practice address
10575 MORANG DR, DETROIT, MI 48224-1880
(313) 884-5477
(313) 884-5478
Mailing address
10575 MORANG DR, DETROIT, MI 48224-1880
(313) 884-5477
(313) 884-5478
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207R00000X
Internal Medicine Physician
Primary
—
MI
225100000X
Physical Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00409105
—
NY
Enumeration date
03/09/2015
Last updated
03/09/2015
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