Grandrapids Regenerative Center PLLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

GRANDRAPIDS REGENERATIVE CENTER PLLC

Practice address

17220 W 12 Mile Rd Ste 129
Southfield, MI 48076-2114

Phone

(617) 819-5841

NPI assigned

Sep 22, 2026

Last updated

Sep 22, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan Hijazi

Title

Owner

Phone

(617) 819-5841

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790035200000",
    "number": "1013820059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17220 W 12 MILE RD STE 129",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17220 W 12 MILE RD STE 129",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762114",
            "telephone_number": "617-819-5841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANDRAPIDS REGENERATIVE CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-22",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A",
        "authorized_official_last_name": "HIJAZI",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-819-5841"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Rae Graham, CRNA
• Troi Graham
• Alison K. Granados, MD
• Sabrina Grandberry
• Reginald Dean Grandison, O.D.
• Krysten Granger
• Mary Lisa Granger
• Darrel Grant
• Julie E Grant
• Mark Grant, D.O.

• Pain Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Pain Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.