Healthcare Provider Details

I. General information

NPI: 1669542247
Provider Name (Legal Business Name): DEARBORN ORTHOPEDICS & SPORTS MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23550 PARK SUITE #100
DEARBORN MI
48124
US

IV. Provider business mailing address

23550 PARK SUITE #100
DEARBORN MI
48124
US

V. Phone/Fax

Practice location:
  • Phone: 313-730-0500
  • Fax: 313-730-0606
Mailing address:
  • Phone: 313-730-0500
  • Fax: 313-730-0606

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS G PLAGENS
Title or Position: M.D.
Credential: M.D.
Phone: 313-730-0500