Southfield Regenerative Medical Center PLLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

SOUTHFIELD REGENERATIVE MEDICAL CENTER PLLC

Practice address

17220 W 12 Mile Rd Ste 200
Southfield, MI 48076-2141

Phone

(313) 284-9433

Fax

(313) 284-3180

NPI assigned

Mar 22, 2024

Last updated

Apr 5, 2024By 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, DONPI 1962864108

Title

Owner

Phone

(313) 284-9433

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ryan Hijazi, D.O

  • Interventional Pain Medicine Physician
  • Warren, MI
  • NPI 1962864108

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1711065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1992565105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17220 W 12 MILE RD STE 205",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762114",
            "telephone_number": "313-284-9433",
            "fax_number": "313-284-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17220 W 12 MILE RD STE 200",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762141",
            "telephone_number": "313-284-9433",
            "fax_number": "313-284-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHFIELD REGENERATIVE MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-22",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "HIJAZI",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-284-9433",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southfield Physical Therapy LLC
• Southfield Premier Primary Care PLLC
• Southfield Premier Urgent Care and Walk-in Clinic PLLC
• Southfield PT Inc
• Southfield Radiology Associates PLLC
• Southfield Rehab Center Inc
• Southfield Rehabilitation Center Inc
• Southfield Rehabilitation Company (Oakland Regional Hospital)
• Southfield Rehabilitation Company (Oakland Nursing Center)
• Southfield Rehabilitation Company (Oakland Regional Hospital)

• 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 Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.