Healthcare Provider Details

I. General information

NPI: 1689986218
Provider Name (Legal Business Name): SJMHS LIVINGSTON ORTHOPEDIC SURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 GRAND RIVER RD SUITE 202
BRIGHTON MI
48114-9309
US

IV. Provider business mailing address

7575 GRAND RIVER RD SUITE 202
BRIGHTON MI
48114-9309
US

V. Phone/Fax

Practice location:
  • Phone: 810-844-7785
  • Fax: 810-844-7567
Mailing address:
  • Phone: 810-844-7785
  • Fax: 810-844-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL KULAS
Title or Position: DIRECTOR
Credential:
Phone: 734-475-4040