Healthcare Provider Details

I. General information

NPI: 1689037749
Provider Name (Legal Business Name): ROCHESTER KNEE & SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 CROSS CREEK PKWY STE 160
AUBURN HILLS MI
48326
US

IV. Provider business mailing address

3100 CROSS CREEK PKWY STE 200
AUBURN HILLS MI
48326-2776
US

V. Phone/Fax

Practice location:
  • Phone: 248-377-8000
  • Fax:
Mailing address:
  • Phone: 248-377-8000
  • Fax: 248-377-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: GARETT SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 248-484-2110