Healthcare Provider Details

I. General information

NPI: 1093907677
Provider Name (Legal Business Name): OSTEOPOROSIS TREATMENT CENTERS OF AMERICA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21031 MICHIGAN AVE
DEARBORN MI
48124-2339
US

IV. Provider business mailing address

38 RIDGE RD
PLEASANT RIDGE MI
48069-1120
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-6700
  • Fax: 313-277-2483
Mailing address:
  • Phone: 313-277-6700
  • Fax: 313-277-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number5101014788
License Number StateMI

VIII. Authorized Official

Name: DR. ALFRED M FAULKNER
Title or Position: PRESIDENT
Credential: DO
Phone: 313-277-6700