Healthcare Provider Details

I. General information

NPI: 1912365032
Provider Name (Legal Business Name): MOVEMENT ORTHOPEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 07/09/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43475 DALCOMA DR SUITE #160
CLINTON TOWNSHIP MI
48038-3591
US

IV. Provider business mailing address

43475 DALCOMA DR SUITE #160
CLINTON TOWNSHIP MI
48038-3591
US

V. Phone/Fax

Practice location:
  • Phone: 586-436-3785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY JOHN CARROLL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 586-436-3785