Provider Demographics
NPI:1992334551
Name:RESTORATIVE PHYSICAL MEDICINE PLLC
Entity type:Organization
Organization Name:RESTORATIVE PHYSICAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-250-2973
Mailing Address - Street 1:42350 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1838
Mailing Address - Country:US
Mailing Address - Phone:248-697-2942
Mailing Address - Fax:
Practice Address - Street 1:42350 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1838
Practice Address - Country:US
Practice Address - Phone:248-697-2942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty