Provider Demographics
NPI:1154177541
Name:PROTERA HEALTH MEDICAL OF MICHIGAN PC
Entity type:Organization
Organization Name:PROTERA HEALTH MEDICAL OF MICHIGAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-331-0939
Mailing Address - Street 1:43313 WOODWARD AVE # 1174
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5007
Mailing Address - Country:US
Mailing Address - Phone:810-331-0939
Mailing Address - Fax:855-850-4055
Practice Address - Street 1:801 W BIG BEAVER RD STE 300
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4725
Practice Address - Country:US
Practice Address - Phone:810-331-0939
Practice Address - Fax:855-850-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty