Healthcare Provider Details

I. General information

NPI: 1881613040
Provider Name (Legal Business Name): SPECIALISTS IN ORTHOPEDIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLIAM CARLS DR RSC @ HVSH
COMMERCE TOWNSHIP MI
48382-2201
US

IV. Provider business mailing address

1 WILLIAM CARLS DR RSC @ HVSH
COMMERCE TOWNSHIP MI
48382-2201
US

V. Phone/Fax

Practice location:
  • Phone: 248-937-4947
  • Fax: 248-937-5150
Mailing address:
  • Phone: 248-937-4947
  • Fax: 248-937-5150

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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARY HATHORNE
Title or Position: BILLER
Credential:
Phone: 248-937-3411