Michiana Spine, Sports & Occupational Rehab, PC

Key facts

NPI

1386902013

Entity type

Organization (NPI type 2)

Primary specialty

Interventional Pain Medicine Physician 208VP0014X

License

4301070312 (MI)

Legal business name

MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC

Practice address

24 N Saint Joseph Ave Ste B
Niles, MI 49120-2263

Phone

(574) 252-4150

Fax

(574) 252-4159

NPI assigned

May 1, 2012

Organization subpart

No

Authorized official

Name

Kevin G Drew, MD NPI 1275538373

Title

Owner

Phone

(574) 252-4150

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Gene Drew, MD Pain Medicine (Physical Medicine & Rehabilitation) Physician · Mishawaka, IN · NPI 1275538373
  NPD Authorized official
• Heidi Rebecca Bell, FNP-BC Family Nurse Practitioner · South Bend, IN · NPI 1821223488
  NPD
• Jonathan D.V. Sanner, DPT Physical Therapist · Mishawaka, IN · NPI 1134672728
  NPD
• Caitlin Vlaeminck Family Nurse Practitioner · South Bend, IN · NPI 1083919161
  NPD
• Karen L Meyer, DO Physical Medicine & Rehabilitation Physician · Alpena, MI · NPI 1831304690
  NPD (past)
• Charles Matthew Gibellato, M.D. Physical Medicine & Rehabilitation Physician · Mechanicsville, VA · NPI 1528013836
  NPD (past)
• Molly Ann Stevens, DPT Physical Therapist · Mentor, OH · NPI 1154572691
  NPD (past)

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 3, 2022.

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1386902013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3740 EDISON LAKES PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453474",
            "telephone_number": "574-252-4150",
            "fax_number": "574-252-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 N SAINT JOSEPH AVE STE B",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202263",
            "telephone_number": "574-252-4150",
            "fax_number": "574-252-4159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "DREW",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-252-4150",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MI",
            "license": "4301070312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

• Michiana Hematology Oncology of Michigan, P.C.
• Michiana Hematology Oncology of Michigan, P.C.
• Michiana Home Care, LLC
• Michiana Mobility LLC
• Michiana Mobility LLC
• Madison Rae Mick, DMD
• Midwest Recovery and Wellness LLC
• Midwest Wellness LLC
• Mike Flewelling DDS PLC
• Marc Thomas Milhander, PH.D.

All providers in Niles, MI · Interventional Pain Medicine Physician in Michigan