Healthcare Provider Details

I. General information

NPI: 1720160963
Provider Name (Legal Business Name): PERFORMANCE ORTHOPEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24255 W 13 MILE RD SUITE 100
BINGHAM FARMS MI
48025-4320
US

IV. Provider business mailing address

24255 W 13 MILE RD SUITE 100
BINGHAM FARMS MI
48025-4320
US

V. Phone/Fax

Practice location:
  • Phone: 248-988-8085
  • Fax: 248-988-8565
Mailing address:
  • Phone: 248-988-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH GUETTLER
Title or Position: OWNER
Credential: M.D
Phone: 248-988-8085