Healthcare Provider Details

I. General information

NPI: 1184162992
Provider Name (Legal Business Name): MICHIGAN ORTHOPAEDIC SURGEONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
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

26025 LAHSER RD THIRD FLOOR
SOUTHFIELD MI
48033-2606
US

V. Phone/Fax

Practice location:
  • Phone: 248-988-8085
  • Fax:
Mailing address:
  • Phone: 248-663-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GUETTLER
Title or Position: EXECUTIVE COMMITEE MEMBER
Credential:
Phone: 248-988-8085