Organization
MD REGENERATION, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE JENNINGS (CREDENTIALING SPECIALIST)
(617) 454-4916
Entity
Organization
Contact information
Practice address
333 W 7TH ST STE 100, ROYAL OAK, MI 48067-2510
(248) 561-0602
Mailing address
41000 WOODWARD AVE STE 350, BLOOMFIELD, MI 48304-5092
(248) 404-0501
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101020789
MI
Other
Enumeration date
02/12/2018
Last updated
08/23/2019
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